University Imaging Center, LLC
Organization Active NPI Diagnostic Radiology Physician · Baltimore, MD
NPI 1245245307 · NPPES record last updated Sep 17, 2024
Key facts
- NPI
- 1245245307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- UNIVERSITY IMAGING CENTER, LLC
- Practice address
- 419 W Redwood St
Suite 110
Baltimore, MD 21201-1734 - Phone
- (410) 328-9130
- Fax
- (410) 328-1009
- NPI assigned
- Jul 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Charles S White, M.D.
- Title
- Vice President
- Phone
- (410) 328-3477
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Member of 1
Practitioners 283
-
Recai Aktay, MD
-
Lara Antonios, MD
-
Omer A Awan, MD
-
Wengen Chen, MD
-
Barry D Daly, MD
-
Derik Davis, MD
-
Florence Xini Doo, M.D.
-
Aletta Ann Frazier, M.D.
-
Dheeraj Gandhi, MD
-
Rinal Goel, M.D.
-
Allison Herring, MD
-
Jeffrey David Hirsch, M.D.
-
Kimia Khalatbari Kani, M.D.
-
Ali Rafiq Khader, M.D.
-
Hyun S Kim, M.D.
-
Vikas Kundra, MD, PHD
-
Barton Frederick Lane, M.D.
-
Lakir Patel, M.D.
-
Beth Anne Pruitt, CRNP, DNP, FNP
-
Prashant Raghavan, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2290493 | University Imaging Center LLC | Certificate of waiver | Sep 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040226000325 | MD | Part B Supplier - Clinic/Group Practice | 2769378686 |
Receives reassigned benefits from 113 practitioners 1 other NPI on this enrollment Practice locations: Baltimore, MD |
| O20140423002053 | DC | Part B Supplier - Clinic/Group Practice | 2769378686 |
Receives reassigned benefits from 20 practitioners Practice locations: Mitchellville, MD; Poolesville, MD; Potomac, MD; Rockville, MD; Chevy Chase, MD; Silver Spring, MD; Washington, DC; Falls Church, VA… |
National Provider Directory
- Tax ID family
- University Imaging Center
Locations
110 S Paca St
Rm 2108
Baltimore, MD 21201
670 W Baltimore St
Baltimore, MD 21201
Phone (410) 328-9130
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Neuroimaging (Radiology) Physician |
2085D0003X | |||
| Neuroradiology Physician |
2085N0700X | |||
| Pediatric Radiology Physician |
2085P0229X | |||
| Diagnostic Radiology Physician |
2085R0202X | Yes | ||
| Vascular & Interventional Radiology Physician |
2085R0204X |
Addresses
Primary practice location
419 W Redwood St
Suite 110
Baltimore, MD 21201-1734
Mailing address
PO Box 64137
Baltimore, MD 21264-4137
Other practice location 1
670 W Baltimore St
Baltimore, MD 21201-1519
Phone (410) 328-9130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 275501700 | Medicaid | MD |
Other providers in Baltimore, MD
- Universal Mental Health Services, LLC
- Universal Surgical Center
- University Care
- University Care LLC
- University Health Services
- University Imaging Center, LLC
- University Imaging Specialists
- University of Maryland
- University of Maryland Anesthesiology Associates P.a.
- University of Maryland Anesthesiology Associates P.a.
All providers in Baltimore, MD · Diagnostic Radiology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.