NPIMap

Organization Active NPI

Illinois Cardiovascular & Thoracic Surgery, LTD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bloomington, IL
National Provider Identifier
1962450734
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD
Practice address
1505 Eastland Dr
Suite 210
Bloomington, IL 61701-7906
Phone
(309) 662-5506
Fax
(309) 662-5443
NPI assigned
May 4, 2006
Last updated
Apr 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Authorized official

Name
Dr. Glen B Smith, M.D.NPI 1326031105
Title
Chiref Operations Officer
Phone
(309) 662-5506

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Interventional Cardiology Physician 207RI0011X NU
Nuclear Cardiology Physician 207UN0901X NU
Vascular & Interventional Radiology Physician 2085R0204X NU
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

1505 Eastland Dr
Suite 210
Bloomington, IL 61701-7906

Mailing address

1505 Eastland Dr
Suite 210
Bloomington, IL 61701-7906
Phone (309) 662-5506

Other identifiers 1

IdentifierTypeStateIssuer
05732036OtherILBLUE SHIELD GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1962450734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 210",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017906",
            "telephone_number": "309-662-5506",
            "fax_number": "309-662-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 210",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017906",
            "telephone_number": "309-662-5506",
            "fax_number": "309-662-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIREF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "309-662-5506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "05732036",
            "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 Apr 24, 2012; 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.