NPIMap

Organization Active NPI

Nomc/Macneal Radiation Therapy Joint Venture, LLC

Doing business as d.b.a.-Berwyn Radiation Oncology Center

  • Radiation Oncology Physician
  • Berwyn, IL
National Provider Identifier
1801829395
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
NOMC/MACNEAL RADIATION THERAPY JOINT VENTURE, LLC
Doing business as
d.b.a.-Berwyn Radiation Oncology Center
Practice address
6801 34TH St
Berwyn, IL 60402-5591
Phone
(708) 484-0011
Fax
(708) 484-0549
NPI assigned
Jul 8, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NUCLEAR ONCOLOGY SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Roger S Krueger
Title
Group Administrator
Phone
(630) 734-9560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X IL Primary

Addresses

Primary practice location

6801 34TH St
Berwyn, IL 60402-5591

Mailing address

PO Box 94
Hiawatha, IA 52233-0094
Phone (319) 826-3763

Other identifiers 1

IdentifierTypeStateIssuer
DE8968OtherILRAILROAD MEDICARE PIN

Other names 1

  • d.b.a.-Berwyn Radiation Oncology Center Doing business as

National Provider Directory

National Provider Directory
Part of
Nuclear-Oncology SC

Locations

7420 Central Ave
River Forest, IL 60305
Phone (708) 763-2700

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1801829395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "city": "HIAWATHA",
            "state": "IA",
            "postal_code": "522330094",
            "telephone_number": "319-826-3763",
            "fax_number": "888-609-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 34TH ST",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604025591",
            "telephone_number": "708-484-0011",
            "fax_number": "708-484-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOMC/MACNEAL RADIATION THERAPY JOINT VENTURE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NUCLEAR ONCOLOGY SC",
        "enumeration_date": "2006-07-08",
        "last_updated": "2022-07-21",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "GROUP ADMINISTRATOR",
        "authorized_official_telephone_number": "630-734-9560",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DE8968",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d.b.a.-Berwyn Radiation Oncology Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "d.b.a.-Berwyn Radiation Oncology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.