Radiology Imaging of Nebraska, LLC
Organization Active NPI Diagnostic Radiology Physician · Scottsbluff, NE
NPI 1184869901 · NPPES record last updated Mar 31, 2024
Key facts
- NPI
- 1184869901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Graceann Grillo
- Title
- Credentialing Supervisor
- Phone
- (720) 493-3716
Practitioners 261
-
Stephen C. Johnson, M.D.
-
Benjamin Ball, MD
-
David W Camacho, MD
-
William Robert Graf, M.D.
-
Arun R Krishnan, MD
-
Felipe Matsunaga, M.D.
-
Shane Morris, M.D.
-
Jon P Nielsen, MD, MPH
-
David J. Quintana, M.D.
-
Samuel H Tesfalidet, M.D.
-
Philippe A. Tirman, M.D.
-
Lori L Wilhelm, MD
-
Daniel Eric Wingard, D.O.
-
Nancy Jean Benedetti, M.D.
-
Gitesh Dhiraj Chheda, M.D.
-
Sean Thomas Walker, M.D.
-
Michael Orin Yung, M.D.
-
Samuel T Ahn, MD
-
Ryan Lloyd Albritton, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in NE, CO, HI, GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
10700 E Geddes Ave
Ste 200
Englewood, CO 80112
400 Indiana St
Ste 130
Golden, CO 80401
Phone (720) 493-3411
222 Johnstown Center Dr
Johnstown, CO 80534
Phone (970) 587-4974
8200 Southpark Ter
Littleton, CO 80120
Phone (720) 493-3251
10107 Ridgegate Pkwy
Ste 110
Lone Tree, CO 80124
Phone (720) 493-3539
10450 Park Meadows Dr
Ste 105
Lone Tree, CO 80124
Phone (303) 925-0075
201 Albert Ave
Scott City, KS 67871
Phone (620) 872-2187
3350 10th St
Gering, NE 69341
Phone (308) 632-2540
3911 Avenue B
Scottsbluff, NE 69361
Phone (308) 630-2100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025709000 | Medicaid | NE | |
| 100262777-00 | Medicaid | NE | |
| 100262778-00 | Medicaid | NE | |
| 1184869901 | Medicaid | IA | |
| 1184869901 | Medicaid | MO |
Other providers in Scottsbluff, NE
- Eva Marie Quevedo
- Quick Care Medical Family Medicine
- Quick Care Medical Services Inc
- Natalee Quintana
- Magdalena Quintanar
- Brooke Marie Raines
- Jason Robert Rairigh
- Amber Ramig
- Dessie Ramirez
- Erica Ramirez
All providers in Scottsbluff, NE · Diagnostic Radiology Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.