Arizona Advanced Imaging Center LLC
Organization Active NPI Magnetic Resonance Imaging (MRI) Clinic/Center · Mesa, AZ
NPI 1124078431 · NPPES record last updated Feb 20, 2019
Key facts
- NPI
- 1124078431
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
- License
- OTC3591 (AZ)
- Legal business name
- ARIZONA ADVANCED IMAGING CENTER LLC
- Practice address
- 4566 E Inverness Ave
Suite 102
Mesa, AZ 85206-4633 - Phone
- (480) 380-7718
- Fax
- (480) 308-7717
- NPI assigned
- May 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Sean Zahniser
- Title
- Ceo
- Phone
- (480) 308-7718
Practitioners 23
-
Gujjarappa Srinivas, M.D.
-
Farres Nitam Uddin Ahmed, M.D.
-
Dennis M Burton, M.D.
-
John Erogul, MD
-
Kenneth C. Fortgang, M.D.
-
Sean L Johnston, M.D., PH.D.
-
Jared M. Kasper, M.D.
-
Sunil Kini, MD
-
Stephen Loos, MD
-
Erik J. Maki, M.D.
-
Philip B. McDonald, M.D.
-
Sandra Jill Althaus, M.D.
-
Ryan E Berecky, MD
-
Betsy Card, M.D.
-
Sheldon M Kop, MD
-
David N Landis, MD
-
Gregg Wayne McAninch, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051110000903 | AZ | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 1254319056 | Practice locations: Mesa, AZ |
| O20130809000228 | AZ | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 1254319056 | Practice locations: Phoenix, AZ |
National Provider Directory
Locations
2301 N 4th St
Flagstaff, AZ 86004
Phone (928) 719-7400
4566 E Inverness Ave
Ste 102
Mesa, AZ 85206
Phone (480) 308-7718
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Magnetic Resonance Imaging (MRI) Clinic/Center | 261QM1200X | OTC3591 | AZ | Yes |
| Radiology Clinic/Center | 261QR0200X | OTC3591 | AZ |
Addresses
Primary practice location
4566 E Inverness Ave
Suite 102
Mesa, AZ 85206-4633
Mailing address
4566 E Inverness Ave Ste 102
Mesa, AZ 85206-4633
Phone (480) 308-7718
Other practice location 1
600 S Dobson Rd Ste E42
Chandler, AZ 85224-5693
Phone (480) 306-7008
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 858532 | Medicaid | AZ | |
| DC2759 | Other | AZ | RAILROAD MEDICARE |
Other providers in Mesa, AZ
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- Arizona Advanced Pain Center
- Arizona Advanced Physical Therapy
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All providers in Mesa, AZ · Magnetic Resonance Imaging (MRI) Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2019. 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.