NPIMap

Advance Technological Radiology, PA

Organization Active NPI Diagnostic Radiology Physician · Davenport, FL

NPI 1154450351 · NPPES record last updated Aug 10, 2021

Key facts

NPI
1154450351
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
ADVANCE TECHNOLOGICAL RADIOLOGY, PA
Practice address
2235 North Boulevard West
Davenport, FL 33837-8990
Phone
(863) 421-9393
Fax
(866) 560-1517
NPI assigned
Mar 5, 2007
Organization subpart
No

Authorized official

Name
Anthony T Rosa, MD NPI 1558497438
Title
Owner
Phone
(863) 421-9393

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 2

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

Practitioners 105

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

View all 105

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040624000229 FL Part B Supplier - Clinic/Group Practice 8527043389 Receives reassigned benefits from 19 practitioners
Practice locations: Davenport, FL; Lake Wales, FL; Winter Haven, FL

National Provider Directory

Tax ID family
Advance Technological Radiology PA (3 organizations share this tax ID)

Locations

2235 North Blvd W
Davenport, FL 33837
Phone (863) 421-8674

433 Linden Ln
Lake Wales, FL 33853
Phone (863) 421-9393

24040 US Highway 27
Lake Wales, FL 33859
Phone (863) 421-9393

315 E Central Ave
Winter Haven, FL 33880
Phone (863) 295-5674

Networks

  • Optimum HealthCare HMO Network
    Plans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • Freedom Health HMO Network
    Plans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2085R0202X Yes

Addresses

Primary practice location

2235 North Boulevard West
Davenport, FL 33837-8990

Mailing address

P.O. Box 2159
Haines City, FL 33845-2159
Phone (863) 421-9393

Other identifiers

IdentifierTypeStateIssuer
255768100MedicaidFL

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://atradiology.cc Health Information Exchange (HIE)

Other providers in Davenport, FL

All providers in Davenport, FL · Diagnostic Radiology Physician in Florida

Sources for this page

Verify at the official NPI Registry.