Ft. Jesse Imaging Center LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

FT. JESSE IMAGING CENTER LLC

Practice address

2200 Fort Jesse Rd
Normal, IL 61761-6286

Phone

(309) 454-5552

NPI assigned

Jan 8, 2018

Organization subpart

No

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

Authorized official

Name

Amy Stout

Title

President/Ceo

Phone

(615) 261-2306

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1104333491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 CRESCENT CENTRE DR STE 200",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370674652",
            "telephone_number": "615-261-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616286",
            "telephone_number": "309-454-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT. JESSE IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-08",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "615-261-2306"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46015604001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Frazier, CRNA
• Kathryn Freckleton
• Shawn Michael Alvin Freehling
• Kelsey Elizabeth Freeman, PA
• Fresenius Medical Care Normal, LLC
• Ft. Jesse Imaging Center LLC
• Kimbra Fuesting, ATC
• David Michael Fuhl, PHARMD
• John D Fulk, P.A.
• Sherry Fulk

• Diagnostic Radiology Physician in Normal, IL
• Providers in Normal, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.