NPIMap

Organization Active NPI

Elevation Medical Imaging Evanston

  • Radiology Clinic/Center
  • Evanston, WY
National Provider Identifier
1184242521
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
ELEVATION MEDICAL IMAGING EVANSTON
Practice address
1485 State Highway 150 S
Evanston, WY 82930-5344
Phone
(307) 444-4215
Fax
(307) 444-4219
NPI assigned
Jul 13, 2020
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Shaun Andrikopoulos
Title
Director Officer
Phone
(307) 444-4215

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1485 State Highway 150 S
Evanston, WY 82930-5344

Mailing address

PO Box 2393
Idaho Falls, ID 83403-2393
Phone (800) 338-5378

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210726000705 WY Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3971906116 Practice locations: Evanston, WY

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1184242521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2393",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032393",
            "telephone_number": "800-338-5378",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 STATE HIGHWAY 150 S",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305344",
            "telephone_number": "307-444-4215",
            "fax_number": "307-444-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATION MEDICAL IMAGING EVANSTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-13",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "ANDRIKOPOULOS",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "DIRECTOR OFFICER",
        "authorized_official_telephone_number": "307-444-4215"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.