All-Stat Portable Wi, LLC

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

ALL-STAT PORTABLE WI, LLC

Practice address

4811 S 76TH St # 405
Greenfield, WI 53220-4364

Phone

(224) 337-0073

Fax

(224) 337-0074

NPI assigned

Feb 27, 2020

Last updated

Aug 26, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

ALL-STAT PORTABLE, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Etai Sooliman

Title

Ceo

Phone

(224) 337-1199

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023642204. Details of each certification follow.

• CCN 52X0009835 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 52X0009835

Legal name

ALL STAT PORTABLE WI

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Nov 23, 2021

Last certification

Nov 23, 2021

Ownership / control type

Corporation

Facility address

4811 S 76TH St Suite 405
Greenfield, WI 53220

Other NPIs with the same Medicare PAC ID 1

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

• All-Stat Portable Wi, LLC

  • Mobile Radiology Clinic/Center
  • Greenfield, WI
  • NPI 1801420823

  4688078207

  Same PAC ID

Tax ID family

All-Stat Portable Wi LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• All-Stat Portable Wi, LLC

  • Mobile Radiology Clinic/Center
  • Greenfield, WI
  • NPI 1801420823
  NPD tax ID

Locations

Practitioners 3

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.

• Justin Hung Pham, M.D.

  • Diagnostic Radiology Physician
  • Rockford, IL
  • NPI 1821040866
  NPD (past)
• Roberto Rivera-Morales, MD

  • Diagnostic Radiology Physician
  • Weston, FL
  • NPI 1992797377
  NPD (past)
• Pradheep J Shanker, M.D.

  • Body Imaging Physician
  • Columbus, OH
  • NPI 1457399818
  NPD (past)

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1023642204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8235 CHRISTIANA AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762910",
            "telephone_number": "224-337-1000",
            "fax_number": "224-337-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 S 76TH ST # 405",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204364",
            "telephone_number": "224-337-0073",
            "fax_number": "224-337-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL-STAT PORTABLE WI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALL-STAT PORTABLE, LLC",
        "enumeration_date": "2020-02-27",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "SOOLIMAN",
        "authorized_official_first_name": "ETAI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "224-337-1199",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alvie Wafiq Ahsan, MD
• Emily Akula
• Janet Jean Alberti, PT
• Regina Lauretta Alberti, RN
• Breanna Nicole Aldred, MD
• All-Stat Portable Wi, LLC
• Allergy, Asthma & Sinus Center, S.C.
• Alliance Foot & Ankle Clinics LLC
• Amanda Marie Allsop, M.S.
• Aracelis Almestica-Jackson, LPN

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Greenfield, WI
• Providers in Greenfield, WI by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.