Smi Imaging LLC
Organization Active NPI Diagnostic Radiology Physician · Henderson, NV
NPI 1124664008 · NPPES record last updated Jul 27, 2020
Key facts
- NPI
- 1124664008
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- SMI IMAGING LLC
- Practice address
- 861 Coronado Center Dr Ste 101
Henderson, NV 89052-3992 - Phone
- (702) 260-2120
- NPI assigned
- Nov 26, 2019
- Organization subpart
- No
Authorized official
- Name
- Howard John Simon, MD
- Title
- Ceo
- Phone
- (480) 478-6545
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 11
Practitioners 5
-
Hideki Ichino, MD
-
Kimberlie Wang, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D2163730 | Simonmed Imaging-Coronado | Certificate of waiver | Mar 19, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180824000170 | NV | Part B Supplier - Clinic/Group Practice | 3476696220 |
Receives reassigned benefits from 56 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Simonmed Imaging
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
861 Coronado Center Dr Ste 101
Henderson, NV 89052-3992
Mailing address
6900 E Camelback Rd Ste 700
Scottsdale, AZ 85251-2400
Phone (866) 614-8555
Other names
- SIMONMED IMAGING
Other providers in Henderson, NV
- Andre Small
- Daniel Small
- Nannie Small
- Smart Start Independent Living LLC
- Smee Wellness LLC
- Smi Imaging LLC
- Smi Imaging LLC
- Smile Dental
- Smile Mas Dental Stephanie PLLC
- Smiles of Alaska LLC
All providers in Henderson, NV · Diagnostic Radiology Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.