NPIMap

Organization Active NPI

Advance Technological Radiology, PA

  • Diagnostic Radiology Physician
  • Davenport, FL
National Provider Identifier
1154450351
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 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
Last updated
Aug 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Authorized official

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

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

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

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

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

National Provider Directory
Tax ID family
Advance Tech Radiology3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

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

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

Networks

  • Freedom Health HMO NetworkPlans: 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 Máximo (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)…
  • Optimum HealthCare HMO NetworkPlans: 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)

Practitioners & affiliated clinicians

Practitioners 105

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1154450351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2159",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338452159",
            "telephone_number": "863-421-9393",
            "fax_number": "866-560-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 NORTH BOULEVARD WEST",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-421-9393",
            "fax_number": "866-560-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE TECHNOLOGICAL RADIOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "ROSA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-421-9393",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://atradiology.cc",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2235 North Boulevard West",
            "city": "Davenport",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338378990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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.