Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 2085R0202X | Radiology | Diagnostic Radiology | 036068882 | ILLINOIS | No |
2 | 2085R0202X | Radiology | Diagnostic Radiology | 25000041 | OHIO | No |
3 | 2085R0202X | Radiology | Diagnostic Radiology | 01060991A | INDIANA | No |
4 | 2085R0202X | Radiology | Diagnostic Radiology | 34114 | WISCONSIN | No |
5 | 2085N0700X | Radiology | Neuroradiology | 036068882 | ILLINOIS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | P00082045 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | RR MED- OLYMPIA FIELDS MR |
2 | K27853 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MERIDIAN-AREA 16 |
3 | 036068882 | MEDICAID | ILLINOIS | |
4 | 212545028 | MEDICARE PIN | ILLINOIS | |
5 | E40234 | MEDICARE UPIN | | |
6 | K06483 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | BUCKTOWN OPEN MRI |
7 | K14422 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | TRI CITIES OPEN MRI |
8 | K27846 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MERIDIAN- AREA 15 |
9 | L82432 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | OPEN MRI @ CORPORATE WOOD |
10 | 202926 | OTHER | ILLINOIS | GROUP PTAN |
11 | 212545 | OTHER | ILLINOIS | GROUP PTAN |
12 | K03540 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | OPEN MRI OLYMPIA FIELDS |
13 | K05183 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | JOLIET OPEN MRI |
14 | K07037 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | PEORIA OPEN MRI |
15 | P00081846 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | RR MED. S.SUB OPEN MRI OR |
16 | 300122116 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MED.RR-CORPORATE WOODS MR |
17 | K27860 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | MERIDIAN -AREA 99 |
18 | K02636 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | S.SUBURBAN OPEN MRI ORLAN |
19 | K16977 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | BLOOMINGDALE OPEN MRI |
20 | K28614 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | RAND IMAGING |
21 | 036068882 | OTHER | ILLINOIS | BLUE SHIELD |
22 | K28069 | MEDICARE ID-TYPE UNSPECIFIED | ILLINOIS | NORTH SHORE PHYSICIANS GR |
23 | 202926020 | MEDICARE PIN | ILLINOIS | |