NPIMap

Organization Active NPI

Radiology Regional Center, PA

  • Diagnostic Radiology Physician
  • Bonita Springs, FL
National Provider Identifier
1174299978
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY REGIONAL CENTER, PA
Practice address
9776 Bonita Beach Rd SE Ste 100
Bonita Springs, FL 34135-4773
Phone
(239) 444-2200
Fax
(239) 444-2210
NPI assigned
Aug 20, 2021
Last updated
Aug 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Brian A Krivisky, MDNPI 1043265952
Title
Ceo
Phone
(239) 936-2316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

9776 Bonita Beach Rd SE Ste 100
Bonita Springs, FL 34135-4773

Mailing address

3660 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316

Other identifiers 1

IdentifierTypeStateIssuer
054636414MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Radiology Regional Center PA13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

9776 Bonita Beach Rd SE
Ste 100
Bonita Springs, FL 34135
Phone (239) 444-2200

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1174299978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 BROADWAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018005",
            "telephone_number": "239-936-2316",
            "fax_number": "239-834-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9776 BONITA BEACH RD SE STE 100",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354773",
            "telephone_number": "239-444-2200",
            "fax_number": "239-444-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY REGIONAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "KRIVISKY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-936-2316",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054636414",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.