Elevation Medical Imaging Gillette

Key facts

NPI: 1003587692
Entity type: Organization (NPI type 2)
Primary specialty: Radiology Clinic/Center 261QR0200X
Legal business name: ELEVATION MEDICAL IMAGING GILLETTE
Practice address: 913 E Boxelder Rd
Gillette, WY 82718
Phone: (307) 682-1779
Fax: (307) 682-1745
NPI assigned: Sep 23, 2021
Organization subpart: No

Authorized official

Name: Shaun Andrikopoulos
Title: Partner
Phone: (307) 682-1779

Practitioners 1

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

John McCormac, M.D. Diagnostic Radiology Physician · Independence, OH · NPI 1235131996

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WY

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20220318001533	WY	Part B Supplier - Independent Diagnostic Testing Facility (Idtf)	4284029737	Practice locations: Gillette, WY

National Provider Directory

Locations

913 E Boxelder Rd
Gillette, WY 82718
Phone (307) 682-1779

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Radiology Clinic/Center	261QR0200X			Yes

Addresses

Primary practice location

913 E Boxelder Rd
Gillette, WY 82718

Mailing address

PO Box 736
Wheat Ridge, CO 80034-0736
Phone (307) 218-8223

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 24, 2023.

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1003587692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 736",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800340736",
            "telephone_number": "307-218-8223",
            "fax_number": "317-218-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 E BOXELDER RD",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "82718",
            "telephone_number": "307-682-1779",
            "fax_number": "307-682-1745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATION MEDICAL IMAGING GILLETTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "ANDRIKOPOULOS",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "307-682-1779"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

All providers in Gillette, WY · Radiology Clinic/Center in Wyoming

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.