NPIMap

Organization Active NPI

Radiology Imaging of Nebraska, LLC

  • Diagnostic Radiology Physician
  • Scottsbluff, NE
National Provider Identifier
1184869901
Registry record updated Mar 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY IMAGING OF NEBRASKA, LLC
Practice address
4021 Avenue B
Scottsbluff, NE 69361-4602
Phone
(308) 635-3711
Fax
(303) 630-1120
NPI assigned
Dec 8, 2008
Last updated
Mar 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2024

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

Authorized official

Name
Graceann Grillo
Title
Credentialing Supervisor
Phone
(720) 493-3716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

4021 Avenue B
Scottsbluff, NE 69361-4602

Mailing address

10800 E Geddes Ave Ste 300
Englewood, CO 80112-3895
Phone (303) 761-9190

Other identifiers 5

IdentifierTypeStateIssuer
10025709000MedicaidNE
1184869901MedicaidMO
100262778-00MedicaidNE
100262777-00MedicaidNE
1184869901MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, CO, HI, GA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20090107000484 NE Part B Supplier - Clinic/Group Practice 5597828269 Receives reassigned benefits from 27 practitioners
Practice locations: Scottsbluff, NE; Oshkosh, NE; Gering, NE; Chadron, NE; Alliance, NE; Gordon, NE
O20090303000126 CO Part B Supplier - Clinic/Group Practice 5597828269 Receives reassigned benefits from 131 practitioners
O20140722000990 HI Part B Supplier - Clinic/Group Practice 5597828269 Receives reassigned benefits from 31 practitioners
Practice locations: Honolulu, HI; Hilo, HI; Kealakekua, HI; Kahuku, HI; Kailua Kona, HI
O20221207003269 GA Part B Supplier - Clinic/Group Practice 5597828269 Receives reassigned benefits from 1 practitioner
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Locations

10800 E Geddes Ave
Ste 300
Englewood, CO 80112
Phone (303) 791-9190

11960 Lioness Way
Ste 100
Parker, CO 80134
Phone (720) 493-3456

11 Paddock St
Crawford, NE 69339
Phone (308) 665-1770

3911 Avenue B
Scottsbluff, NE 69361
Phone (308) 630-2100

Practitioners & affiliated clinicians

Practitioners 261

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 261

NPI Registry JSON

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711843200000",
    "number": "1184869901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 E GEDDES AVE STE 300",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801123895",
            "telephone_number": "303-761-9190",
            "fax_number": "720-874-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 AVENUE B",
            "city": "SCOTTSBLUFF",
            "state": "NE",
            "postal_code": "693614602",
            "telephone_number": "308-635-3711",
            "fax_number": "303-630-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY IMAGING OF NEBRASKA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2024-03-31",
        "certification_date": "2024-03-31",
        "status": "A",
        "authorized_official_last_name": "GRILLO",
        "authorized_official_first_name": "GRACEANN",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "720-493-3716"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025709000",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184869901",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262778-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262777-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184869901",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsbluff, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2024; 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.