NPIMap

Organization Active NPI

Radiology Consultants a Professional Corp

  • Diagnostic Radiology Physician
  • Fairbanks, AK
National Provider Identifier
1124056734
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY CONSULTANTS A PROFESSIONAL CORP
Practice address
1650 Cowles St
Fairbanks, AK 99701-5925
Phone
(907) 458-5660
Fax
(903) 663-9960
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Suzan Bast
Title
Practice Manager
Phone
(907) 460-1762

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5925

Mailing address

PO Box 70378
Fairbanks, AK 99707-0378
Phone (907) 456-2784

Other identifiers 1

IdentifierTypeStateIssuer
GR0138MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, WI, IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040203000194 AK Part B Supplier - Clinic/Group Practice 0749173029 Receives reassigned benefits from 11 practitioners
Practice locations: Fairbanks, AK
O20240108004031 WI Part B Supplier - Clinic/Group Practice 0749173029 Receives reassigned benefits from 2 practitioners
Practice locations: Madison, WI; Verona, WI
O20260526000271 IL Part B Supplier - Clinic/Group Practice 0749173029 Receives reassigned benefits from 1 practitioner
Practice locations: Oak Brook, IL

National Provider Directory

National Provider Directory

Locations

1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1124056734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70378",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997070378",
            "telephone_number": "907-456-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015925",
            "telephone_number": "907-458-5660",
            "fax_number": "903-663-9960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY CONSULTANTS A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "BAST",
        "authorized_official_first_name": "SUZAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "907-460-1762"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0138",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.