Active NPI
Jack T Sandford, MD
- Radiation Oncology Physician
- Carterville, IL
National Provider Identifier
1801835913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 036104428
- Practice address
- 10286 Fleming Rd
Carterville, IL 62918-3351 - Phone
- (618) 985-4000
- Fax
- (618) 985-4155
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 036104428 | IL | Primary |
Addresses
Primary practice location
10286 Fleming Rd
Carterville, IL 62918-3351
Mailing address
1020A E Boal Ave
Boalsburg, PA 16827-1509
Phone (814) 237-8627
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036104428 | Medicaid | IL | |
| 10027422 | Other | IL | IL BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marion Anesthesia Company LLC | Past | Accepting new patients | |
| Marion Diagnostic Center, LLC | Past | Accepting new patients | |
| Tri-State Radiation Oncology, Inc. | Radiation Oncology | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Marion, IL
- NPI 1790721579
-
- Multi-Specialty Clinic/Center
- Marion, IL
- NPI 1366543084
-
- Radiation Oncology Clinic/Center
- Bullhead City, AZ
- NPI 1518264829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1801835913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020A E BOAL AVE",
"city": "BOALSBURG",
"state": "PA",
"postal_code": "168271509",
"telephone_number": "814-237-8627",
"fax_number": "814-238-0083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10286 FLEMING RD",
"city": "CARTERVILLE",
"state": "IL",
"postal_code": "629183351",
"telephone_number": "618-985-4000",
"fax_number": "618-985-4155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDFORD",
"first_name": "JACK",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "IL",
"license": "036104428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036104428",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL BCBS",
"identifier": "10027422",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carterville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.