NPIMap

Organization Active NPI

Northeast Open MRI, Inc

Doing business as Northeast Open MRI

  • Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1033130240
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTHEAST OPEN MRI, INC
Doing business as
Northeast Open MRI
Practice address
9815 Roosevelt Boulevard
Suite K
Philadelphia, PA 19114
Phone
(215) 335-1100
Fax
(215) 335-5370
NPI assigned
Jul 22, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Mr. Bruce Miller
Title
President
Phone
(215) 335-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

9815 Roosevelt Boulevard
Suite K
Philadelphia, PA 19114

Mailing address

9815 Roosevelt Boulevard
Suite K
Philadelphia, PA 19114
Phone (215) 335-1100

Other names 1

  • Northeast Open MRI Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050303000595 PA Part B Supplier - Clinic/Group Practice 5193794386 Receives reassigned benefits from 11 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

8400 Roosevelt Blvd
Philadelphia, PA 19152
Phone (215) 331-1366

9815 Roosevelt Blvd
Ste K
Philadelphia, PA 19114
Phone (215) 335-1100

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1033130240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9815 ROOSEVELT BOULEVARD",
            "address_2": "SUITE K",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19114",
            "telephone_number": "215-335-1100",
            "fax_number": "215-335-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 ROOSEVELT BOULEVARD",
            "address_2": "SUITE K",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19114",
            "telephone_number": "215-335-1100",
            "fax_number": "215-335-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OPEN MRI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-335-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.