NPIMap

Organization Active NPI

Proscan Imaging of Indianapolis, LLC

  • Diagnostic Radiology Physician
  • Avon, IN
National Provider Identifier
1043370174
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PROSCAN IMAGING OF INDIANAPOLIS, LLC
Practice address
5250 E US Highway 36
Prestwick Pointe Suite 220
Avon, IN 46123-9199
Phone
(317) 745-3200
Fax
(317) 745-4214
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

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

Authorized official

Name
Michael D. O'Brien
Title
Coo
Phone
(513) 281-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

5250 E US Highway 36
Prestwick Pointe Suite 220
Avon, IN 46123-9199

Mailing address

5250 E US Highway 36
Prestwick Pointe Suite 220
Avon, IN 46123-9199

Other identifiers 1

IdentifierTypeStateIssuer
000000477513OtherANTHEM PIN

Other names 1

  • ProScan Imaging of Avon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070208000063 IN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 5991706301 Practice locations: Avon, IN

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Proscan Imaging of in LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201219200000",
    "number": "1043370174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5250 E US HIGHWAY 36",
            "address_2": "PRESTWICK POINTE SUITE 220",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 E US HIGHWAY 36",
            "address_2": "PRESTWICK POINTE SUITE 220",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239199",
            "telephone_number": "317-745-3200",
            "fax_number": "317-745-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSCAN IMAGING OF INDIANAPOLIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-01-25",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "513-281-3400"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000477513",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProScan Imaging of Avon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; 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.