NPIMap

Organization Active NPI

Radia Imaging Center Holdings LLC

  • Diagnostic Radiology Physician
  • Vancouver, WA
National Provider Identifier
1154942886
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIA IMAGING CENTER HOLDINGS LLC
Practice address
4816 NE Thurston Way Ste a
Vancouver, WA 98662-6661
Phone
(360) 254-4914
Fax
(360) 449-4987
NPI assigned
May 5, 2020
Organization subpart
Yes
Parent organization
RADIA INC PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Authorized official

Name
Bart Patrick Keogh, MDNPI 1669489472
Title
President
Phone
(425) 563-1500

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 MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

4816 NE Thurston Way Ste a
Vancouver, WA 98662-6661

Mailing address

19020 33Rd Ave W Ste 210
Lynnwood, WA 98036-4748
Phone (425) 563-1500

Other practice location 1

3520 SE 164th Ave Ste 108
Vancouver, WA 98683
Phone (360) 254-4914

Other names 1

  • Vancouver Radiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190118000572 WA Part B Supplier - Clinic/Group Practice 6305182965 Receives reassigned benefits from 230 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Radia Medical Imaging E

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4816 NE Thurston Way
Ste A
Vancouver, WA 98662
Phone (360) 254-4914

Practitioners & affiliated clinicians

Practitioners 87

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

View all 87

NPI Registry JSON

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588636800000",
    "number": "1154942886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19020 33RD AVE W STE 210",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364748",
            "telephone_number": "425-563-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4816 NE THURSTON WAY STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626661",
            "telephone_number": "360-254-4914",
            "fax_number": "360-449-4987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3520 SE 164th Ave Ste 108",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "98683",
            "country_code": "US",
            "telephone_number": "360-254-4914",
            "fax_number": "360-449-4987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RADIA IMAGING CENTER HOLDINGS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIA INC PS",
        "enumeration_date": "2020-05-05",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A",
        "authorized_official_last_name": "KEOGH",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-563-1500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vancouver Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; 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.