NPIMap

Organization Active NPI

Wayne Macomb Diagnostic Imaging Center Inc

  • Diagnostic Radiology Physician
  • Chicago, IL
National Provider Identifier
1326042235
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2085R0202X Issued in MI
Legal business name
WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC
Practice address
8690 Reliable
Chicago, IL 60686-0001
Phone
(586) 775-6400
Fax
(586) 498-1559
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Authorized official

Name
Mrs. Carole Zupan
Title
Administrative Director
Phone
(586) 435-2031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 2085R0202X MI Primary

Addresses

Primary practice location

8690 Reliable
Chicago, IL 60686-0001

Mailing address

18245 E 10 Mile Rd
Ste 100
Roseville, MI 48066-5807
Phone (586) 775-6400

Other identifiers 11

IdentifierTypeStateIssuer
000000005320OtherMICAPE MEDICAL
P42884OtherMIBLUE CARE NETWORK
104972OtherMIPREFERRED CHOICES
1207380001OtherMIWELLNESS PLAN
8331930OtherMIAETNA PPO
70097BOtherMIHEALTH ALLIANCE PLAN
148899OtherMIGREAT LAKES HEALTH PLAN
300E06144OtherMIBLUE CROSS
RA820051OtherMIM CARE
M015025OtherMICHAMPUS-TRICARE
0525947OtherMIAETNA HMO

Other names 1

  • Wayne Macomb MRI Center Doing business as

National Provider Directory

National Provider Directory

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8690 Reliable Pkwy
Chicago, IL 60686

8690 Reliable
Chicago, IL 60686
Phone (586) 775-6400

18245 E 10 Mile Rd
Ste 100
Roseville, MI 48066
Phone (586) 775-6400

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1326042235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18245 E 10 MILE RD",
            "address_2": "STE 100",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665807",
            "telephone_number": "586-775-6400",
            "fax_number": "586-498-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8690 RELIABLE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "586-775-6400",
            "fax_number": "586-498-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MACOMB DIAGNOSTIC IMAGING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "ZUPAN",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "586-435-2031",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "2085R0202X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE MEDICAL",
            "identifier": "000000005320",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P42884",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "104972",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLNESS PLAN",
            "identifier": "1207380001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "8331930",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "70097B",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "148899",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "300E06144",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M CARE",
            "identifier": "RA820051",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS-TRICARE",
            "identifier": "M015025",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0525947",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne Macomb MRI Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.