NPIMap

Organization Active NPI

Panhandle Radiology PLLC

  • Diagnostic Radiology Physician
  • Guymon, OK
National Provider Identifier
1104018571
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
23914 Issued in OK
Legal business name
PANHANDLE RADIOLOGY PLLC
Practice address
350 NE 12TH St
Guymon, OK 73942-3624
Phone
(580) 338-6515
Fax
(580) 225-5423
NPI assigned
Aug 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

Name
Robert A Williams, MD
Title
Physician Owner
Phone
(580) 338-6515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 23914 OK Primary

Addresses

Primary practice location

350 NE 12TH St
Guymon, OK 73942-3624

Mailing address

PO Box 1030
Guymon, OK 73942-1030
Phone (580) 338-6515

Other identifiers 2

IdentifierTypeStateIssuer
DG3161OtherOKRAILROAD MEDICARE
200118900AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071017000710 OK Part B Supplier - Clinic/Group Practice 7315033669 Receives reassigned benefits from 10 practitioners
Practice locations: Guymon, OK

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1104018571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1030",
            "city": "GUYMON",
            "state": "OK",
            "postal_code": "739421030",
            "telephone_number": "580-338-6515",
            "fax_number": "580-225-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 NE 12TH ST",
            "city": "GUYMON",
            "state": "OK",
            "postal_code": "739423624",
            "telephone_number": "580-338-6515",
            "fax_number": "580-225-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANHANDLE RADIOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "580-338-6515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "23914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG3161",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200118900A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Guymon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.