NPIMap

Organization Active NPI

Tellica Imaging, LLC

  • Radiology Clinic/Center
  • Nashua, NH
National Provider Identifier
1003510322
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
TELLICA IMAGING, LLC
Practice address
345 Amherst St Ste 3
Nashua, NH 03063-1754
Phone
(603) 292-3006
NPI assigned
Mar 29, 2023
Organization subpart
Yes
Parent organization
INTERMOUNTAIN HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
Mark Vawdrey
Title
Chief Financial Officer
Phone
(801) 718-1642

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

345 Amherst St Ste 3
Nashua, NH 03063-1754

Mailing address

36 S State St Ste 2200
Salt Lake City, UT 84111-1470

Other practice location 1

1100 Bicentennial Dr
Manchester, NH 03104-2173
Phone (610) 772-7252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231201000761 UT Part B Supplier - Clinic/Group Practice 3577950765 Receives reassigned benefits from 117 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Murray, UT; Salt Lake City, UT
O20240729002071 NH Part B Supplier - Clinic/Group Practice 3577950765 Receives reassigned benefits from 5 practitioners
Practice locations: Manchester, NH; Nashua, NH

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Duchesne Valley Clinic

Locations

5217 S State St
Ste 200
Salt Lake City, UT 84107
Phone (208) 417-5100

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1003510322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 S STATE ST STE 2200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 AMHERST ST STE 3",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030631754",
            "telephone_number": "603-292-3006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Bicentennial Dr",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "031042173",
            "country_code": "US",
            "telephone_number": "610-772-7252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TELLICA IMAGING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN HEALTHCARE",
        "enumeration_date": "2023-03-29",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "VAWDREY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "801-718-1642"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashua, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.