NPIMap

Organization Active NPI

Portage Radiology, SC

  • Diagnostic Radiology Physician
  • Portage, WI
National Provider Identifier
1104834811
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PORTAGE RADIOLOGY, SC
Practice address
2817 New Pinery Rd
Portage, WI 53901-9257
Phone
(608) 742-4131
Fax
(608) 826-2710
NPI assigned
Aug 4, 2006
Last updated
May 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Authorized official

Name
Dr. Craig N Magnes, MDNPI 1346258068
Title
Owner
Phone
(608) 742-4131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

2817 New Pinery Rd
Portage, WI 53901-9257

Mailing address

2817 New Pinery Rd
Portage, WI 53901-9257
Phone (608) 742-4131

Other identifiers 1

IdentifierTypeStateIssuer
21266400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040131000075 WI Part B Supplier - Clinic/Group Practice 8022911536 Receives reassigned benefits from 8 practitioners
Practice locations: Portage, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525824000000",
    "number": "1104834811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131",
            "fax_number": "608-826-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131",
            "fax_number": "608-826-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE RADIOLOGY, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2018-05-09",
        "status": "A",
        "authorized_official_last_name": "MAGNES",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-742-4131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21266400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; 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.