NPIMap

Organization Active NPI

Shared Magnetic Resonance Imaging Facility, Inc

Doing business as SSM Health Cancer Center

  • Radiation Oncology Clinic/Center
  • Madison, WI
National Provider Identifier
1780640532
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
Legal business name
SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC
Doing business as
SSM Health Cancer Center
Practice address
1104 John Nolen Dr
Suite 1
Madison, WI 53713-1430
Phone
(608) 251-6868
Fax
(608) 251-4255
NPI assigned
Apr 21, 2006
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara J Thiermann
Title
Executive Director
Phone
(608) 259-4438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X NU Primary

Addresses

Primary practice location

1104 John Nolen Dr
Suite 1
Madison, WI 53713-1430

Mailing address

1104 John Nolen Dr
Suite 1
Madison, WI 53713-1430
Phone (608) 251-6868

Other identifiers 1

IdentifierTypeStateIssuer
32828800MedicaidWI

Other names 1

  • SSM Health Cancer Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000022 WI Part B Supplier - Clinic/Group Practice 8921906256 Receives reassigned benefits from 11 practitioners
Practice locations: Baraboo, WI; Janesville, WI; Madison, WI

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1104 John Nolen Dr
#1
Madison, WI 53713
Phone (608) 251-6868

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1780640532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 JOHN NOLEN DR",
            "address_2": "SUITE 1",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131430",
            "telephone_number": "608-251-6868",
            "fax_number": "608-251-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 JOHN NOLEN DR",
            "address_2": "SUITE 1",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537131430",
            "telephone_number": "608-251-6868",
            "fax_number": "608-251-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARED MAGNETIC RESONANCE IMAGING FACILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "THIERMANN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "608-259-4438"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32828800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.