NPIMap

Organization Active NPI

Penrad Imaging LLC

  • Radiology Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1003906868
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
PENRAD IMAGING LLC
Practice address
3050 N Circle Dr
Colorado Springs, CO 80909-1175
Phone
(719) 785-9001
Fax
(719) 867-7900
NPI assigned
Oct 13, 2006
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Authorized official

Name
Derek Scott Bergeson, MD
Title
Radiologist
Phone
(719) 593-1799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary

Addresses

Primary practice location

3050 N Circle Dr
Colorado Springs, CO 80909-1175

Mailing address

PO Box 2989
Colorado Springs, CO 80901-2989
Phone (719) 593-1799

Other identifiers 1

IdentifierTypeStateIssuer
04143046MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, AZ, OR, VA, WA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040420001609 CO Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 26 practitioners
1 other NPI on this enrollment
Practice locations: Colorado Springs, CO; Monument, CO
O20221026002261 AZ Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 2 practitioners
Practice locations: Cave Creek, AZ; Phoenix, AZ
O20230127000828 OR Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, OR; Lake Oswego, OR
O20230227002230 VA Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 1 practitioner
Practice locations: Chesapeake, VA
O20241023000574 WA Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 1 practitioner
Practice locations: Camas, WA

Other NPIs with the same Medicare PAC ID 2

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D1090669Penrad Imaging3050 N Circle Drive, Colorado Springs, CO 80909Certificate of waiverOct 15, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1390 Kelly Johnson Blvd
Colorado Springs, CO 80920
Phone (714) 400-6934

320 E Fontanero St
Ste 105
Colorado Springs, CO 80907
Phone (719) 632-0545

3220 N Academy Blvd
Ste 2
Colorado Springs, CO 80917
Phone (719) 596-5440

17230 Jackson Creek Pkwy
Ste 160
Monument, CO 80132
Phone (719) 785-9000

Networks

  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1003906868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809012989",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 N CIRCLE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091175",
            "telephone_number": "719-785-9001",
            "fax_number": "719-867-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENRAD IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "719-593-1799",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04143046",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.