NPIMap

Organization Active NPI

Central Illinois Neuroradiology, LTD

  • Specialist
  • Bloomington, IL
National Provider Identifier
1881641371
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CENTRAL ILLINOIS NEURORADIOLOGY, LTD
Practice address
1709 Jumer Dr
Suite B
Bloomington, IL 61704-0909
Phone
(309) 664-6808
Fax
(309) 664-6809
NPI assigned
May 28, 2006
Last updated
Oct 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2007

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

Authorized official

Name
Mr. Dexter Hall
Title
Manager
Phone
(314) 821-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X IL Primary

Addresses

Primary practice location

1709 Jumer Dr
Suite B
Bloomington, IL 61704-0909

Mailing address

1715 Deer Tracks TRL
Suite 130
Saint Louis, MO 63131-1839
Phone (314) 821-5600

Other identifiers 2

IdentifierTypeStateIssuer
CH0689OtherILRAILROAD MEDICARE GROUP #
5723741OtherILBCBS GROUP #

National Provider Directory

National Provider Directory

Locations

1401 Eastland Dr
#C
Bloomington, IL 61701
Phone (309) 663-8311

2501 Compass Rd
#105A
Glenview, IL 60026
Phone (847) 535-6900

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1881641371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 DEER TRACKS TRL",
            "address_2": "SUITE 130",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311839",
            "telephone_number": "314-821-5600",
            "fax_number": "314-821-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 JUMER DR",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617040909",
            "telephone_number": "309-664-6808",
            "fax_number": "309-664-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS NEURORADIOLOGY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "DEXTER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-821-5600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CH0689",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "5723741",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.

Verify at the official NPI Registry.