NPIMap

Organization Active NPI

Stadium Open MRI, LLC

Doing business as ProScan Imaging Paycor Stadium

  • Diagnostic Radiology Physician
  • Cincinnati, OH
National Provider Identifier
1225028335
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0677IC Issued in OH
Legal business name
STADIUM OPEN MRI, LLC
Doing business as
ProScan Imaging Paycor Stadium
Practice address
6 Paycor Stadium
Cincinnati, OH 45202-3418
Phone
(513) 455-4999
Fax
(513) 455-4998
NPI assigned
Oct 28, 2005
Last updated
May 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Daniel Alexander Barber
Title
Director, RCM
Phone
(513) 316-9385

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0677IC OH Primary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X NU

Addresses

Primary practice location

6 Paycor Stadium
Cincinnati, OH 45202-3418

Mailing address

6 Paycor Stadium
Cincinnati, OH 45202-3418
Phone (513) 455-4999

Other identifiers 4

IdentifierTypeStateIssuer
200473300AMedicaidIN
000000332753OtherOHANTHEM PIN
2228888MedicaidOH
86000585MedicaidKY

Other names 1

  • ProScan Imaging Paycor Stadium Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825001634 OH Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 6709850555 Practice locations: Cincinnati, OH

National Provider Directory

National Provider Directory

Locations

6 Paycor Stadium
Cincinnati, OH 45202
Phone (513) 455-4999

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1225028335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PAYCOR STADIUM",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452023418",
            "telephone_number": "513-455-4999",
            "fax_number": "513-455-4998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 PAYCOR STADIUM",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452023418",
            "telephone_number": "513-455-4999",
            "fax_number": "513-455-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STADIUM OPEN MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "BARBER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "DIRECTOR, RCM",
        "authorized_official_telephone_number": "513-316-9385"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "0677IC",
            "primary": true
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200473300A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000332753",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2228888",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86000585",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProScan Imaging Paycor Stadium",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.