Active NPI
Irving Radiology, Inc
- Diagnostic Radiology Physician
- Bloomington, IN
National Provider Identifier
1184305526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- IRVING RADIOLOGY, INC
- Practice address
- 4011 S Monroe Medical Park Blvd
Bloomington, IN 47403 - Phone
- (239) 309-0602
- NPI assigned
- Jul 28, 2023
- Last updated
- Jul 18, 2025
- Organization subpart
- Yes
- Parent organization
- IRVING RADIOLOGY, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Winston Dacosta Irving
- Title
- Owner
- Phone
- (314) 935-0770
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
4011 S Monroe Medical Park Blvd
Bloomington, IN 47403
Mailing address
13690 Eagle Ridge Dr
Fort Myers, FL 33912-1864
Phone (239) 309-0602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99119700A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230929000815 | IN | Part B Supplier - Clinic/Group Practice | 3971881178 |
Receives reassigned benefits from 1 practitioner Practice locations: Bloomington, IN |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Irving Radiology Inc
- Part of
- Irving Radiology Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Diagnostic Radiology Physician
- Chicago, IL
- NPI 1336031871
-
- Diagnostic Radiology Physician
- Lehigh Acres, FL
- NPI 1346698669
-
- Diagnostic Radiology Physician
- East Liverpool, OH
- NPI 1760374292
Locations
13690 Eagle Ridge Dr
Fort Myers, FL 33912
Phone (239) 214-8187
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": "1690502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1752796800000",
"number": "1184305526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13690 EAGLE RIDGE DR",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339121864",
"telephone_number": "239-309-0602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4011 S MONROE MEDICAL PARK BLVD",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "47403",
"telephone_number": "239-309-0602"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IRVING RADIOLOGY, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "IRVING RADIOLOGY, INC",
"enumeration_date": "2023-07-28",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A",
"authorized_official_last_name": "IRVING",
"authorized_official_first_name": "WINSTON",
"authorized_official_middle_name": "DACOSTA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "314-935-0770",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "99119700A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
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- Integ Health System, P.C. (The Eye Center of Southern Indiana)
- Irish Home Care, Inc. (Elara Caring)
- Dreyton Irvin
- Zoe Isaac-Allen
- Julissa Isais
- Islamic Home Care of America LLC
- Abdulrahim Ismail, MD
- James Alexander Isom, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.