NPIMap

Organization Active NPI

Blue Radiology Services LLC

  • Diagnostic Radiology Physician
  • Wellington, FL
National Provider Identifier
1174976468
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BLUE RADIOLOGY SERVICES LLC
Practice address
10101 Forest Hill Blvd
Wellington, FL 33414-6103
Phone
(561) 766-1301
Fax
(561) 693-0539
NPI assigned
Jul 21, 2016
Last updated
Nov 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Authorized official

Name
Daniela Ghiragossian
Title
Practice Administrator
Phone
(561) 268-6509

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

10101 Forest Hill Blvd
Wellington, FL 33414-6103

Mailing address

1155 S Congress Ave Ste C
Palm Springs, FL 33406-5114
Phone (561) 766-1300

Other practice location 1

39200 Hooker Hwy
Belle Glade, FL 33430-5368
Phone (561) 766-1300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161019001652 FL Part B Supplier - Clinic/Group Practice 9032407382 Receives reassigned benefits from 63 practitioners
Practice locations: Wimauma, FL; Westlake, FL; Wellington, FL; Lakewood Ranch, FL; Bradenton, FL; Sarasota, FL; Belle Glade, FL

National Provider Directory

National Provider Directory
Tax ID family
Blue Radiology Services LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

16504 US 301 S
Wimauma, FL 33598
Phone (813) 642-1000

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1174976468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 S CONGRESS AVE STE C",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334065114",
            "telephone_number": "561-766-1300",
            "fax_number": "561-693-0539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 FOREST HILL BLVD",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146103",
            "telephone_number": "561-766-1301",
            "fax_number": "561-693-0539"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39200 Hooker Hwy",
            "address_purpose": "LOCATION",
            "city": "Belle Glade",
            "state": "FL",
            "postal_code": "334305368",
            "country_code": "US",
            "telephone_number": "561-766-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE RADIOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "GHIRAGOSSIAN",
        "authorized_official_first_name": "DANIELA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "561-268-6509"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.