NPIMap

Individual provider Active NPI

Jacob Samuel Witt, M.D.

  • Radiation Oncology Physician
  • O'Fallon, IL
National Provider Identifier
1891157871
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
036150707 Issued in IL
Practice address
321 Regency Park Ste 100
O Fallon, IL 62269-1887
Phone
(618) 416-7970
Fax
(618) 416-7971
NPI assigned
Mar 28, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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 036150707 IL Primary

Addresses

Primary practice location

321 Regency Park Ste 100
O Fallon, IL 62269-1887

Mailing address

PO Box 25228
Decatur, IL 62525-5228
Phone (217) 329-3232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, 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
I20191016001815 IL Practitioner - Radiation Oncology 0749551505 Reassigns benefits to 1 organization
I20191230001555 WI Practitioner - Radiation Oncology 0749551505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

321 Regency Park
Suite 100
O Fallon, IL 62269-1887
Phone (618) 416-7970

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036150707ILMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Nov 15, 2019 Accepting new patients
Cancer Care Specialists of Central Illinois, S.C CurrentSince Jul 1, 2021 Accepting new patients
Mercy Health System Corporation CurrentSince Nov 15, 2019 Accepting new patients
Cancer Care Specialists of Central Illinois, S.C. Radiation Oncology CurrentSince Jul 1, 2021 Accepting new patients
Mercy Health System Corporation Current Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

210 W McKinley Ave
Ste 1
Decatur, IL 62526
Phone (217) 876-6600

210 W McKinley Ave
Ste 2
Decatur, IL 62526
Phone (217) 876-6600

210 W McKinley Ave
#1
Decatur, IL 62526
Phone (217) 877-9442

210 W McKinley Ave
#2
Decatur, IL 62526
Phone (217) 876-4700

905 Medical Park Dr
Effingham, IL 62401
Phone (217) 342-2066

321 Regency Park
Ste 100
O Fallon, IL 62269
Phone (618) 416-7970

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1891157871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25228",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625255228",
            "telephone_number": "217-329-3232",
            "fax_number": "217-233-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 REGENCY PARK STE 100",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691887",
            "telephone_number": "618-416-7970",
            "fax_number": "618-416-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "JACOB",
        "middle_name": "SAMUEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-28",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": "036150707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

Verify at the official NPI Registry.