NPIMap

Organization Active NPI

Radiation Medicine Institute

  • Specialist
  • Evanston, IL
National Provider Identifier
1871685149
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036-083680 Issued in IL
Legal business name
RADIATION MEDICINE INSTITUTE
Practice address
2650 Ridge Ave
Evanston, IL 60201-1718
Phone
(814) 570-2590
Fax
(847) 570-1878
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
William Bloomer, M.D.NPI 1033158639
Title
President/Radiation Medicine Inst.
Phone
(847) 570-2590

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 036-083680 IL Primary

Addresses

Primary practice location

2650 Ridge Ave
Evanston, IL 60201-1718

Mailing address

9818 Eagle Way
Chicago, IL 60678-1098
Phone (630) 285-1530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623000961 IL Part B Supplier - Clinic/Group Practice 8426033366 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Evanston, IL; Glenview, IL; Highland Park, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Jeanette M Moulthrop MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2650 Ridge Ave
Ste G311
Evanston, IL 60201

2650 Ridge Ave
Ste G355
Evanston, IL 60201

801 S Milwaukee Ave
Bldg 880
Libertyville, IL 60048
Phone (847) 990-5910

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1366070400000",
    "number": "1871685149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9818 EAGLE WAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606781098",
            "telephone_number": "630-285-1530",
            "fax_number": "630-285-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "814-570-2590",
            "fax_number": "847-570-1878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIATION MEDICINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "BLOOMER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/RADIATION MEDICINE INST.",
        "authorized_official_telephone_number": "847-570-2590",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036-083680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; 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.