NPIMap

Individual provider Active NPI

Charles Raymond Shideman, M.D., PH.D.

  • Radiation Oncology Physician
  • Saint Paul, MN
National Provider Identifier
1841466026
Registry record updated Oct 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
54992 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2502
Phone
(651) 254-2039
Fax
(651) 254-9333
NPI assigned
May 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 54992 MN Primary

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2502

Mailing address

7401 Metro Blvd Ste 210
Edina, MN 55439-3086
Phone (952) 920-4915

Other identifiers 1

IdentifierTypeStateIssuer
1841466026OtherMNNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120808000415 MN Practitioner - Radiation Oncology 6608022561 Reassigns benefits to 1 organization
I20180424001628 WI Practitioner - Radiation Oncology 6608022561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Minnesota Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minneapolis Radiation Oncology PAGroup PAC ID 8527951094, 18 clinicians

Practice addresses (Care Compare)

501 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2950

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-2039

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
54992MNMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. Past Accepting new patients
Mid-Minnesota Radiation Oncology, PA 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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506988800000",
    "number": "1841466026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 METRO BLVD STE 210",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393086",
            "telephone_number": "952-920-4915",
            "fax_number": "952-915-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-2039",
            "fax_number": "651-254-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIDEMAN",
        "first_name": "CHARLES",
        "middle_name": "RAYMOND",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-07",
        "last_updated": "2017-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MN",
            "license": "54992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841466026",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.