West Stanly Imaging LLC – Radiology Clinic/Center

Key facts

NPI: 1124294194
Entity type: Organization (NPI type 2)
Primary specialty: Radiology Clinic/Center 261QR0200X
Legal business name: WEST STANLY IMAGING LLC
Practice address: 103 Stanly Pkwy
Suite E
Locust, NC 28097-7704
Phone: (704) 781-0003
NPI assigned: Apr 30, 2008
Organization subpart: No

Authorized official

Name: Brian Freeman
Title: President
Phone: (704) 984-4393

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

West Stanly Imaging LLC Magnetic Resonance Imaging (MRI) Clinic/Center · Locust, NC · NPI 1528567088

Same PAC ID 8820150329

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

West Stanly Imaging LLC Magnetic Resonance Imaging (MRI) Clinic/Center · Locust, NC · NPI 1528567088

NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

The Charlotte-Mecklenburg Hospital Authority Orthopaedic Surgery Physician · Denver, NC · NPI 1477884302

NPD member Member Of
The Charlotte-Mecklenburg Hospital Authority Psychiatric Hospital Unit · Concord, NC · NPI 1629283866

NPD member Member Of

Practitioners 4

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

Wade Richard Wilkerson, M.D. Diagnostic Radiology Physician · Albemarle, NC · NPI 1891971354

Medicare reassignment NPD NC
Christopher James Heald, MD Diagnostic Radiology Physician · Dallas, TX · NPI 1972983823

Medicare reassignment NPD NC
Peter B Gusmer, MD Diagnostic Radiology Physician · Albemarle, NC · NPI 1740285469

NPD
Richard Bradford Perry, MD Diagnostic Radiology Physician · Charleston, SC · NPI 1467839811

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NC

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20081217000355	NC	Part B Supplier - Independent Diagnostic Testing Facility (Idtf)	8820150329	Receives reassigned benefits from 2 practitioners Practice locations: Locust, NC

National Provider Directory

Tax ID family: Atrium Health Imaging Locust (2 organizations share this tax ID)

Locations

103 Stanly Pkwy
Ste E
Locust, NC 28097
Phone (704) 781-0003

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Radiology Clinic/Center	261QR0200X			Yes
Physiological Laboratory	293D00000X

Addresses

Primary practice location

103 Stanly Pkwy
Suite E
Locust, NC 28097-7704

Mailing address

PO Box 686
Albemarle, NC 28002-0686

Other identifiers

Identifier	Type	State	Issuer
8105034	Medicaid	NC
020XF	Other	NC	BCBS OF NORTH
P00670112	Other		RAILROAD MEDICARE

Other names

Atrium Health Imaging Locust Doing business as

Other providers in Locust, NC

All providers in Locust, NC · Radiology Clinic/Center in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2021. 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.

Verify at the official NPI Registry.