NPIMap

Organization Active NPI

Premier Mountain Imaging Center

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Lakeside, AZ
National Provider Identifier
1184302002
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
PREMIER MOUNTAIN IMAGING CENTER
Practice address
5448 White Mountain Blvd Ste 110
Lakeside, AZ 85929-5736
Phone
(888) 488-2702
Fax
(888) 235-9876
NPI assigned
Jul 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Mr. Rakesh Pahwa
Title
Owner
Phone
(888) 488-2702

Specialties & licenses 2

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

Addresses

Primary practice location

5448 White Mountain Blvd Ste 110
Lakeside, AZ 85929-5736

Mailing address

5448 White Mountain Blvd Ste 110
Lakeside, AZ 85929-5736
Phone (888) 488-2702

Other names 1

  • Premier Mountain Imaging Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240222003361 AZ Part B Supplier - Clinic/Group Practice 7810344769 Receives reassigned benefits from 6 practitioners
Practice locations: Lakeside, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1184302002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5448 WHITE MOUNTAIN BLVD STE 110",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295736",
            "telephone_number": "888-488-2702",
            "fax_number": "888-235-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5448 WHITE MOUNTAIN BLVD STE 110",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295736",
            "telephone_number": "888-488-2702",
            "fax_number": "888-235-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MOUNTAIN IMAGING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "PAHWA",
        "authorized_official_first_name": "RAKESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-488-2702",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Mountain Imaging Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakeside, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.