Portage Radiology, SC
Organization Active NPI Diagnostic Radiology Physician · Portage, WI
NPI 1104834811 · NPPES record last updated May 9, 2018
Key facts
- NPI
- 1104834811
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Craig N Magnes, MD
- Title
- Owner
- Phone
- (608) 742-4131
Practitioners 9
-
Craig N Magnes, MD
-
Philip Richard Albert, M.D.
-
Richard Clutson, MD
-
Robert D Lefsrud, MD
-
Furquaan M Isa, MD
-
Michelle Debra Rossmann, M.D.
-
Michael J Wilbur, M.D.
-
Kevin M Rak, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040131000075 | WI | Part B Supplier - Clinic/Group Practice | 8022911536 |
Receives reassigned benefits from 8 practitioners Practice locations: Portage, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21266400 | Medicaid | WI |
Other providers in Portage, WI
- Jill Elizabeth Pogorelec
- Joshua Martin Pogorelec
- Danielle Rae Pollex-Rabl
- Portage Care Living LLC
- Portage Community Schools
- Portcare Home LLC
- Andrew Taylor Putney
- Richard J Qualy
- Susan I Quiriconi
- Matthew Gregory Rajala
All providers in Portage, WI · Diagnostic Radiology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.