NPIMap

Organization Active NPI

Austin Diagnostic Clinic, PA

  • Diagnostic Radiology Physician
  • Austin, TX
National Provider Identifier
1194790451
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
AUSTIN DIAGNOSTIC CLINIC, PA
Practice address
12221 Mopac Expressway North
Dept of Imaging Services
Austin, TX 78758-2483
Phone
(512) 901-8729
Fax
(512) 901-8755
NPI assigned
Feb 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

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

Authorized official

Name
Ellen M Andrew
Title
Credentialing Specialist
Phone
(512) 901-4937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Radiologic TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 247100000X

Addresses

Primary practice location

12221 Mopac Expressway North
Dept of Imaging Services
Austin, TX 78758-2483

Mailing address

12221 Mopac Expressway North
Dept of Imaging Services
Austin, TX 78758-2483
Phone (512) 901-8729

Other identifiers 1

IdentifierTypeStateIssuer
140347945MedicaidTX

Other names 1

  • Austin Diagnostic Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000236 TX Part B Supplier - Clinic/Group Practice 1254244551 Receives reassigned benefits from 132 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory
Tax ID family
The Austin Diagnositc C20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

12221 Mopac
Austin, TX 78758
Phone (512) 480-8151

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": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1194790451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MOPAC EXPRESSWAY NORTH",
            "address_2": "DEPT OF IMAGING SERVICES",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582483",
            "telephone_number": "512-901-8729",
            "fax_number": "512-901-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MOPAC EXPRESSWAY NORTH",
            "address_2": "DEPT OF IMAGING SERVICES",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582483",
            "telephone_number": "512-901-8729",
            "fax_number": "512-901-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUSTIN DIAGNOSTIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "ANDREW",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "512-901-4937"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "247100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140347945",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Austin Diagnostic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; 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.