NPIMap

Organization Active NPI

South Philadelphia Open MRI, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1326364613
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
94-170-171 Issued in PA
Legal business name
SOUTH PHILADELPHIA OPEN MRI, LLC
Practice address
1834 West Oregon Avenue
Philadelphia, PA 19145
Phone
(215) 336-4000
Fax
(215) 336-4055
NPI assigned
Apr 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Bruce Miller
Title
President
Phone
(215) 336-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X 94-170-171 PA Primary

Addresses

Primary practice location

1834 West Oregon Avenue
Philadelphia, PA 19145

Mailing address

1834 West Oregon Avenue
Philadelphia, PA 19145
Phone (215) 336-4000

Other names 1

  • South Philadelphia Open MRI Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100910000796 PA Part B Supplier - Clinic/Group Practice 8123142825 Receives reassigned benefits from 11 practitioners
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

3310 S 20th St
Ste B
Philadelphia, PA 19145

1834 W Oregon Ave
Philadelphia, PA 19145
Phone (215) 336-4000

1554 Garrett Rd
Upper Darby, PA 19082
Phone (610) 259-3200

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1271116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1326364613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1834 WEST OREGON AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19145",
            "telephone_number": "215-336-4000",
            "fax_number": "215-336-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 WEST OREGON AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19145",
            "telephone_number": "215-336-4000",
            "fax_number": "215-336-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PHILADELPHIA OPEN MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-13",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-336-4000"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "PA",
            "license": "94-170-171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Philadelphia Open MRI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Philadelphia Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.