NPIMap

Organization Active NPI

Indiana University Health Proton Therapy Center, LLC

  • Radiation Oncology Clinic/Center
  • Bloomington, IN
National Provider Identifier
1780775163
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X
License
NA
Legal business name
INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER, LLC
Practice address
2425 Milo B. Sampson Lane
Bloomington, IN 47408-1398
Phone
(812) 349-5074
Fax
(812) 349-5046
NPI assigned
Sep 28, 2006
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Mr. John Kerstiens, CPA
Title
Coo/Cfo
Phone
(812) 349-5028

Specialties & licenses 1

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

Addresses

Primary practice location

2425 Milo B. Sampson Lane
Bloomington, IN 47408-1398

Mailing address

2425 Milo B. Sampson Lane
Bloomington, IN 47408-1398
Phone (812) 349-5074

Other identifiers 1

IdentifierTypeStateIssuer
200442910AMedicaidIN

Other names 1

  • Midwest Proton Radiotherapy Institute, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

7390 Reliable Pkwy
Chicago, IL 60686

2401 N Milo B Sampson Ln
Bloomington, IN 47408
Phone (812) 855-5194

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1780775163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 MILO B. SAMPSON LANE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474081398",
            "telephone_number": "812-349-5074",
            "fax_number": "812-349-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 MILO B. SAMPSON LANE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474081398",
            "telephone_number": "812-349-5074",
            "fax_number": "812-349-5046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH PROTON THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "KERSTIENS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "812-349-5028",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200442910A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Proton Radiotherapy Institute, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.