Active NPI
Ft. Jesse Imaging Center LLC
- Radiology Clinic/Center
- Normal, IL
National Provider Identifier
1245287143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Clinic/Center
- License
- 9256804
- Legal business name
- FT. JESSE IMAGING CENTER LLC
- Practice address
- 2200 Fort Jesse Rd
Suite 130
Normal, IL 61761-6286 - Phone
- (309) 454-5552
- Fax
- (309) 454-5452
- NPI assigned
- May 27, 2006
- Last updated
- Dec 16, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Stout
- Title
- President/Ceo
- Phone
- (615) 261-2306
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiology Clinic/Center | 261QR0200X | 9256804 | IL | Primary |
| Mammography Clinic/Center | 261QR0206X | 9256804 | IL | |
| Diagnostic Radiology Physician | 2085R0202X |
Addresses
Primary practice location
2200 Fort Jesse Rd
Suite 130
Normal, IL 61761-6286
Mailing address
2200 Fort Jesse Rd
Suite 130
Normal, IL 61761-6286
Phone (309) 454-5552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46015604001 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, OH, NY, VA, FL, AL, CO, CA, MO, WI
Enrollment records 10
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba OSF Saint Clare Medical Center
- Clinic/Center
- Princeton, IL
- NPI 1790363505
Member Of
-
dba OSFMG - Bloomington
- Family Medicine Physician
- Bloomington, IL
- NPI 1871547414
Member Of
Practitioners & affiliated clinicians
Practitioners 21
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.
-
- Diagnostic Radiology Physician
- Springfield, IL
- NPI 1831359512
-
- Diagnostic Ultrasound Physician
- Normal, IL
- NPI 1982639621
Diagnostic Radiology
-
- Diagnostic Radiology Physician
- Normal, IL
- NPI 1265471486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1765843200000",
"number": "1245287143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 FORT JESSE RD",
"address_2": "SUITE 130",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616286",
"telephone_number": "309-454-5552",
"fax_number": "309-454-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT JESSE RD",
"address_2": "SUITE 130",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616286",
"telephone_number": "309-454-5552",
"fax_number": "309-454-5452"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FT. JESSE IMAGING CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-27",
"last_updated": "2025-12-16",
"certification_date": "2025-12-16",
"status": "A",
"authorized_official_last_name": "STOUT",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "615-261-2306"
},
"taxonomies": [
{
"code": "261QR0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology",
"state": "IL",
"license": "9256804",
"primary": true
},
{
"code": "261QR0206X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology, Mammography",
"state": "IL",
"license": "9256804",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "46015604001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.