NPIMap

Organization Active NPI

Radiologic Associates of Northwest Arizona PLC

  • Diagnostic Radiology Physician
  • Fort Mohave, AZ
National Provider Identifier
1316483720
Registry record updated Mar 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGIC ASSOCIATES OF NORTHWEST ARIZONA PLC
Practice address
5330 S Highway 95
Fort Mohave, AZ 86426-9225
Phone
(928) 788-7228
NPI assigned
Jan 9, 2017
Last updated
Mar 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2017

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

Authorized official

Name
William R KelleyNPI 1780666560
Title
MD
Phone
(928) 234-5883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

5330 S Highway 95
Fort Mohave, AZ 86426-9225

Mailing address

4825 S Highway 95
Suite 2 #502
Fort Mohave, AZ 86426-8315
Phone (928) 788-7232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, MD, CA, TX, GA, IL, NY, FL8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20170501002243 AZ Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 3 practitioners
Practice locations: Bullhead City, AZ; Fort Mohave, AZ; Gilbert, AZ; Peoria, AZ; Somerton, AZ
O20200702000152 MD Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 1 practitioner
Practice locations: White Plains, MD
O20200702000847 CA Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 3 practitioners
Practice locations: Newport Beach, CA; Newport Coast, CA
O20200706001127 TX Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 1 practitioner
Practice locations: Lewisville, TX
O20200706001532 GA Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 4 practitioners
Practice locations: Atlanta, GA; Brookhaven, GA
O20200713000031 IL Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 2 practitioners
Practice locations: Chicago, IL; Roselle, IL; South Barrington, IL
O20200728003063 NY Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 2 practitioners
Practice locations: New York, NY; Sag Harbor, NY
O20201209002602 FL Part B Supplier - Clinic/Group Practice 1355628215 Receives reassigned benefits from 1 practitioner
Practice locations: Palm City, FL

National Provider Directory

National Provider Directory

Locations

1355 Ramar Rd
Ste 12
Bullhead City, AZ 86442
Phone (928) 634-6304

4825 S Highway 95
Ste 2
Fort Mohave, AZ 86426

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1316483720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 S HIGHWAY 95",
            "address_2": "SUITE 2 #502",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864268315",
            "telephone_number": "928-788-7232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 S HIGHWAY 95",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864269225",
            "telephone_number": "928-788-7228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGIC ASSOCIATES OF NORTHWEST ARIZONA PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "928-234-5883"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mohave, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; 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.