North Florida Cancer Center Tallahassee LLC

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

Legal business name

NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC

Doing business as

Capital Regional Cancer Center

Practice address

2003 Centre Pointe Blvd
Tallahassee, FL 32308-4893

Phone

(850) 878-2273

Fax

(850) 671-5900

NPI assigned

Sep 30, 2005

Last updated

May 1, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joan R Gladney

Title

Regional Director

Phone

(352) 474-6190

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Capital Regional Cancer Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Eric Eui-Sun Chung, MD

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1427257823
  Medicare reassignment Care Compare group NPD
• Joshua Brian Dault, MD

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1154775724
  Medicare reassignment Care Compare group NPD
• Timothy William Bolek

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1568460285
  Medicare reassignment NPD
• Cherylle A Hayes, M.D.

  • Radiation Oncology Physician
  • Gainesville, FL
  • NPI 1588649479
  Medicare reassignment NPD
• Rizwan D Nurani, MD

  • Radiation Oncology Physician
  • Apple Valley, CA
  • NPI 1386756245

  FL

  Medicare reassignment NPD
• Dale Alan Wickstrum, MD

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1306890322
  NPD

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1952398448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 CENTRE POINTE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084893",
            "telephone_number": "850-878-2273",
            "fax_number": "850-671-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 CENTRE POINTE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084893",
            "telephone_number": "850-878-2273",
            "fax_number": "850-671-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA CANCER CENTER TALLAHASSEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "352-474-6190"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "21130",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272084100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD1687",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Regional Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kendall Lee Norman, M.S., CCC-SLP
• Colby Norris, PA
• James Norris
• Lori Sue Norris, ARNP
• North FL Regional Thyroid
• North Florida Cares, Inc.
• North Florida Infectious Disease Associates LLC
• North Florida Medical Centers, Inc. (North Monroe Medical Center)
• North Florida Medical Centers, Inc.
• North Florida Mental Health, LLC

• Radiation Oncology Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Radiation Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.