ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD (NPI# 1962450734) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962450734 |
| Entity Type | Organization |
| Organization Name | ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD |
| Practice Address |
1505 Eastland Dr Suite 210 Bloomington IL 61701-7906 |
| Practice Telephone | 3096625506 |
| Practice Fax Number | 3096625443 |
| Mailing Telephone | 3096625506 |
| Mailing Fax Number | 3096625443 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2012-04-24 |
| Authorized Official Name | DR. GLEN B SMITH (CHIREF OPERATIONS OFFICER) |
| Authorized Official Telephone | 3096625506 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE SHIELD GROUP NUMBER | 05732036 | 01 |
| Street Address |
1505 EASTLAND DR SUITE 210 |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-7906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336142017 | Yogesh K Agarwal | Internal Medicine | 1505 Eastland Dr, Ste 330, Bloomington, IL 61701-3534 | 2005-05-24 |
| 1073082384 | Caroline J Turner | Nurse Practitioner | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2018-11-15 |
| 1548755366 | Sunanda R Kale | Nurse Practitioner | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2018-06-25 |
| 1790294403 | Sarah Kneip | Nurse Practitioner | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2017-09-26 |
| 1760909626 | Hannah K Corley | Nurse Practitioner | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2017-08-23 |
| 1467827592 | Kelly Karr | Registered Nurse | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2015-12-01 |
| 1205219607 | Michele Krieger-johnsen | Nurse Practitioner | 1505 Eastland Dr, Bloomington, IL 61701-7905 | 2015-07-02 |
| 1326420563 | Fresenius Medical Care Normal, LLC | Clinic/Center | 1505 Eastland Dr, Medical Plaza Lower Level, Bloomington, IL 61701-3534 | 2015-06-24 |
| 1588068803 | Allison Vogel | Physician Assistant | 1505 Eastland Dr, Bloomington, IL 61701-3534 | 2014-10-15 |
| 1578964987 | Kristin N Wilkins | Clinical Nurse Specialist | 1505 Eastland Dr, Suite 320, Bloomington, IL 61701-3534 | 2014-09-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140964 | County of Mclean | Community/Behavioral Health | 200 W Front St, 1st Floor Sw, C/o 200 W Front St, Suite 400f, Bloomington, IL 61701 | 2019-05-22 |
| 1023525292 | Karli Johnson | Counselor | 200 W Monroe St Ste C7, Bloomington, IL 61701 | 2018-01-09 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1215396288 | Heidi Larsen | Social Worker | 902 S East St, Bloomington, IL 61701 | 2016-02-18 |
| 1558735126 | Andrea E. Andrews Counseling LLC | Counselor | 200 W. Monroe St., Ste 302 C, Bloomington, IL 61701 | 2015-11-19 |
| 1174924856 | Carole Hahn | Dietitian, Registered | 1406 Forrest St, Bloomington, IL 61701 | 2014-09-12 |
| 1558786392 | Valerie Colleen Parker | Counselor | 109 W. Mulberry St., Bloomington, IL 61701 | 2014-03-04 |
| 1124459219 | Matilde Francois | Surgery | 1505 Eastland Dr Ste 2300, Bloomington, IL 61701 | 2013-11-27 |
| 1922435114 | Smitha H Shivaprasad | Pharmacist | 2611 East Oakland Avenue, Bloomington, IL 61701 | 2013-10-02 |
| 1295161941 | Ashvin Patel | Obstetrics & Gynecology | 31 Country Club Pl, Bloomington, IL 61701 | 2013-09-25 |
| Find all providers in zip 61701 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780682781 | Bryan E. Mcdonnell | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 707 W 2nd St, Bloomington, IN 47403-2209 | 2005-07-13 |
| 1639276199 | David W. Hart | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 707 W 2nd St, Bloomington, IN 47403-2209 | 2006-09-19 |
| 1063449080 | David H Savage | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 707 W 2nd St, Bloomington, IN 47403-2209 | 2006-06-26 |
| 1538152319 | Ruel N Wright | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1505 Eastland Dr, Suite 210, Bloomington, IL 61701-7906 | 2005-08-26 |
| 1326031105 | Glen B Smith | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1505 Eastland Dr, Suite 210, Bloomington, IL 61701-7906 | 2005-08-26 |
| 1366435224 | Jesse L Vanle | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1505 Eastland Dr, Suite 210, Bloomington, IL 61701-7906 | 2005-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205363041 | Sachowdhry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1 S Summit Ave, Oakbrook Terrace, IL 60181-2212 | 2017-05-11 |
| 1760930028 | Hiroto Kitahara | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5841 S. Maryland Avenue M/c6040, Chicago, IL 60637 | 2016-09-15 |
| 1720440282 | Azad Karim | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 441 E Erie St Apt 1803441, Chicago, IL 60611-4446 | 2016-03-24 |
| 1982002838 | Milton Weinberg Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 983 Kirkhill Ln, Lake Forest, IL 60045-4209 | 2014-12-09 |
| 1235557190 | Bartlomiej Imielski | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 201 E. Huron St., Galter 11-140, Chicago, IL 60611 | 2014-03-28 |
| 1841635869 | Aaron Maxwell Kime | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 133 E Brush Hill Rd Ste 200, Elmhurst, IL 60126-5661 | 2013-05-03 |
| 1952744823 | Walter Lee Barker | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2912 N. Commonwealth Ave., #11c, Chicago, IL 60657-6235 | 2013-04-10 |
| 1952641649 | Willard A Fry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1500 Sheridan Rd, #10e, Wilmette, IL 60091-1873 | 2013-02-18 |
| 1487903092 | Horizons In Healthcare LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 372 Red Bud Ct., Frankfort, IL 60423-2128 | 2012-08-29 |
| 1518215284 | Paul Naffah | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6161 So County Line Rd, Burr Ridge, IL 60527 | 2012-08-28 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
Please comment or provide details below to improve the information on ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.