Individual provider Active NPI

Justin Puopolo, D.O.

  • Diagnostic Radiology Physician
  • Las Vegas, NV
National Provider Identifier
1154556314
Registry record updated Oct 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
DO1947 Issued in NV
Practice address
5495 S Rainbow Blvd Ste 101
Las Vegas, NV 89118-1872
Phone
(702) 477-0772
NPI assigned
May 18, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X DO1947 NV Primary

Addresses

Primary practice location

5495 S Rainbow Blvd Ste 101
Las Vegas, NV 89118-1872

Mailing address

PO Box 30077
Salt Lake City, UT 84130-0077
Phone (702) 477-0772

Other practice location 1

5100 W Broad St
Columbus, OH 43228-1607
Phone (614) 544-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702002265 NV Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 8224275672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
J Paul Wiesner and Associates CharteredGroup PAC ID 4880679976, 24 clinicians
Pueblo Medical Imaging LLCGroup PAC ID 2264328319, 22 clinicians

Practice addresses (Care Compare)

102 E Lake Mead Pkwy
Henderson, NV 89015-5575
Phone (702) 616-4585

1155 Raiders Way
Henderson, NV 89052-4670
Phone (702) 963-7000

1299 Bertha Howe Ave
Mesquite, NV 89027-7500
Phone (702) 346-8040

1409 E Lake Mead Blvd
North Las Vegas, NV 89030-7120
Phone (702) 657-5507

1941 Jefferson St
Suite 105
North Las Vegas, NV 89030-6960
Phone (702) 228-0031

2628 W Charleston Blvd
Las Vegas, NV 89102-2176
Phone (702) 228-0031

3001 Saint Rose Pkwy
Henderson, NV 89052-3839
Phone (702) 616-5585

5495 S Rainbow Blvd
Suite 101
Las Vegas, NV 89118-1872
Phone (702) 228-0031

8280 W Warm Springs Rd
Las Vegas, NV 89113-3612
Phone (702) 616-5000

8551 W Lake Mead Blvd
Suite 150
Las Vegas, NV 89128-7649
Phone (702) 228-0031

901 Adams Blvd
Boulder City, NV 89005-2213
Phone (702) 293-4111

Hospital & facility affiliations

  • Saint Rose Dominican Hospitals - Siena Campus Hospital, Henderson, NV, CCN 290045
  • Henderson Hospital Hospital, Henderson, NV, CCN 290057
  • Saint Rose Dominican Hospitals - San Martin Campus Hospital, Las Vegas, NV, CCN 290053
  • West Henderson Hospital Hospital, Henderson, NV, CCN 290062
  • Mesa View Regional Hospital Hospital, Mesquite, NV, CCN 291307

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
13160CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
J Paul Wiesner & Associates Chartered Diagnostic Radiology CurrentSince May 1, 2015 Accepting new patients
Pueblo Medical Imaging, LLC Diagnostic Radiology CurrentSince May 1, 2015 Accepting new patients

Locations

102 E Lake Mead Pkwy
Henderson, NV 89015
Phone (701) 564-2622

100 N Green Valley Pkwy
Ste 130
Henderson, NV 89074
Phone (702) 990-7417

8551 W Lake Mead Blvd
Ste 150
Las Vegas, NV 89128
Phone (702) 683-5516

2628 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 644-0500

5495 S Rainbow Blvd
Ste 101
Las Vegas, NV 89118
Phone (702) 214-9729

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508457600000",
    "number": "1154556314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30077",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300077",
            "telephone_number": "702-477-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5495 S RAINBOW BLVD STE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891181872",
            "telephone_number": "702-477-0772"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5100 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432281607",
            "country_code": "US",
            "telephone_number": "614-544-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUOPOLO",
        "first_name": "JUSTIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2017-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NV",
            "license": "DO1947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.