Gleason Diagnostic Imaging, PC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2676 Issued in IA

Legal business name

GLEASON DIAGNOSTIC IMAGING, PC

Practice address

1015 Union St
Boone, IA 50036-4821

Phone

(515) 432-3140

Fax

(515) 433-8916

NPI assigned

Oct 20, 2006

Organization subpart

No

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

Authorized official

Name

Greg A Haar

Title

Manager

Phone

(515) 230-3363

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043392665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2085",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511040085",
            "telephone_number": "515-230-3363",
            "fax_number": "712-239-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 UNION ST",
            "city": "BOONE",
            "state": "IA",
            "postal_code": "500364821",
            "telephone_number": "515-432-3140",
            "fax_number": "515-433-8916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEASON DIAGNOSTIC IMAGING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAAR",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "515-230-3363"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "2676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0415497",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.