NPIMap

Organization Active NPI

Oregon Advanced Imaging, LLC

  • Magnetic Resonance Imaging Radiologic Technologist
  • Medford, OR
National Provider Identifier
1134416464
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging Radiologic TechnologistTaxonomy code 2471M1202X
Legal business name
OREGON ADVANCED IMAGING, LLC
Practice address
881 Ohare Pkwy
Medford, OR 97504-4005
Phone
(541) 608-8791
Fax
(541) 608-0376
NPI assigned
Jul 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Authorized official

Name
Mrs. Lynette K Gundlach
Title
Comptroller
Phone
(541) 608-8791

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Computed Tomography Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 2471C3401X
Magnetic Resonance Imaging Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 2471M1202X Primary
Nuclear Medicine Technology Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 2471N0900X

Addresses

Primary practice location

881 Ohare Pkwy
Medford, OR 97504-4005

Mailing address

PO Box 1527
Medford, OR 97501-0114
Phone (541) 608-8791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111011000777 OR Part B Supplier - Clinic/Group Practice 3577465376 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
Practice locations: Central Point, OR; Medford, OR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1107 Crater Lake Ave
Medford, OR 97504
Phone (541) 608-8791

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1134416464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1527",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010114",
            "telephone_number": "541-608-8791",
            "fax_number": "541-608-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 OHARE PKWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044005",
            "telephone_number": "541-608-8791",
            "fax_number": "541-608-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON ADVANCED IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "GUNDLACH",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "541-608-8791",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2471C3401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2471N0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Nuclear Medicine Technology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; 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.