Premier Diagnostic Imaging LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

XF201098 Issued in IN

Legal business name

PREMIER DIAGNOSTIC IMAGING LLC

Practice address

135 E McCallister Dr
Terre Haute, IN 47802-4247

Phone

(812) 478-3900

Fax

(812) 478-5868

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jayaprakasarao Konijeti, M.D.

Title

Medical Director

Phone

(812) 478-3900

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1023049806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E MCCALLISTER DR",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478024247",
            "telephone_number": "812-478-3900",
            "fax_number": "812-478-5868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E MCCALLISTER DR",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478024247",
            "telephone_number": "812-478-3900",
            "fax_number": "812-478-5868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "KONIJETI",
        "authorized_official_first_name": "JAYAPRAKASARAO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "812-478-3900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "XF201098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200514950",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Terre Haute, IN
• Providers in Terre Haute, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.