Organization Active NPI

St Vincent Northwest Radiology LLC

  • Diagnostic Radiology Physician
  • Fishers, IN
National Provider Identifier
1114978350
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST VINCENT NORTHWEST RADIOLOGY LLC
Practice address
11201 USA Pkwy
Suite 140
Fishers, IN 46037-9202
Phone
(317) 913-8910
NPI assigned
May 12, 2006
Last updated
Jun 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

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

Authorized official

Name
Linda A Wilgus
Title
Executive Director
Phone
(317) 328-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

11201 USA Pkwy
Suite 140
Fishers, IN 46037-9202

Mailing address

5901 Technology Center Dr
Indianapolis, IN 46278-6013
Phone (317) 328-5050

Other identifiers 1

IdentifierTypeStateIssuer
200182900MedicaidIN

National Provider Directory

National Provider Directory

Locations

13590 Collections Ctr
Chicago, IL 60693

11201 USA Pkwy
#140
Fishers, IN 46037
Phone (317) 913-8910

Practitioners & affiliated clinicians

Practitioners 49

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.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1114978350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 TECHNOLOGY CENTER DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462786013",
            "telephone_number": "317-328-5050",
            "fax_number": "317-715-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 USA PKWY",
            "address_2": "SUITE 140",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379202",
            "telephone_number": "317-913-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT NORTHWEST RADIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "WILGUS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "317-328-5050"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200182900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; 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.