NPIMap

Organization Active NPI

Quality Medical Imaging of Nevada LLC.

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Las Vegas, NV
National Provider Identifier
1104823368
Registry record updated May 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
License
LLC5073-2001 Issued in NV
Legal business name
QUALITY MEDICAL IMAGING OF NEVADA LLC.
Practice address
2490 Professional CT
Suite 110
Las Vegas, NV 89128-0825
Phone
(702) 839-1133
Fax
(702) 851-1616
NPI assigned
Jul 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2016

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

Authorized official

Name
Mr. Roger C Faselt
Title
President
Phone
(702) 839-1133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X LLC5073-2001 NV Primary

Addresses

Primary practice location

2490 Professional CT
Suite 110
Las Vegas, NV 89128-0825

Mailing address

2490 Professional CT
Suite 110
Las Vegas, NV 89128-0825
Phone (702) 839-1133

Other identifiers 2

IdentifierTypeStateIssuer
630001670OtherNVRAILROAD MEDICARE ID
002702036MedicaidNV

Other names 1

  • Quality Medical Imaging Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040413000664 NV Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7113911140 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV
O20040712000688 NV Part B Supplier - Portable X-Ray Supplier 7113911140 Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1120262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464134400000",
    "number": "1104823368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 PROFESSIONAL CT",
            "address_2": "SUITE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280825",
            "telephone_number": "702-839-1133",
            "fax_number": "702-851-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 PROFESSIONAL CT",
            "address_2": "SUITE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280825",
            "telephone_number": "702-839-1133",
            "fax_number": "702-851-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY MEDICAL IMAGING OF NEVADA LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-02",
        "last_updated": "2016-05-25",
        "status": "A",
        "authorized_official_last_name": "FASELT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-839-1133",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NV",
            "license": "LLC5073-2001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID",
            "identifier": "630001670",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002702036",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Medical Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; 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.