NPIMap

Organization Active NPI

Quality Medical Imaging of Nevada LLC

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Las Vegas, NV
National Provider Identifier
1295992998
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
Legal business name
QUALITY MEDICAL IMAGING OF NEVADA LLC
Practice address
2490 Professional CT
Ste 110
Las Vegas, NV 89128-0835
Phone
(702) 839-1133
Fax
(702) 851-1616
NPI assigned
May 20, 2008
Last updated
May 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

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

Authorized official

Name
Roger Carl Faselt
Title
President
Phone
(702) 839-1133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X NU Primary

Addresses

Primary practice location

2490 Professional CT
Ste 110
Las Vegas, NV 89128-0835

Mailing address

2490 Professional CT
Ste 110
Las Vegas, NV 89128-0835
Phone (702) 839-1133

Other identifiers 2

IdentifierTypeStateIssuer
2702036MedicaidNV
630001670OtherNVRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413000664 NV Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7113911140 1 other NPI on this enrollment
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1295992998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 PROFESSIONAL CT",
            "address_2": "STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280835",
            "telephone_number": "702-839-1133",
            "fax_number": "702-851-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 PROFESSIONAL CT",
            "address_2": "STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280835",
            "telephone_number": "702-839-1133",
            "fax_number": "702-851-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY MEDICAL IMAGING OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "FASELT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-839-1133"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2702036",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "630001670",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.