Gaston Radiology PA

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

GASTON RADIOLOGY PA

Practice address

620 Summit Crossing PL
Ste 106
Gastonia, NC 28054-2176

Phone

(704) 867-8021

Fax

(704) 864-4606

NPI assigned

Nov 22, 2005

Organization subpart

No

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

Authorized official

Name

Eric Jax

Title

Chief Operating Officer

Phone

(704) 867-8021

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in NC, SC, ME, AZ, PA, OH, CA, GA, FL9 enrollments

Enrollment records 9

Locations

Practitioners 49

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

• Diane Huntington Conley, MD

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1528032604

  FL

  Medicare reassignment Care Compare group NPD
• Gregory John Duellman, D.O.

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1417029455
  Medicare reassignment Care Compare group NPD
• Mark Thomas Edge, PHD MD

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1003899766
  Medicare reassignment Care Compare group NPD
• Charles John Girard II, M.D.

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1659540219
  Medicare reassignment Care Compare group NPD
• Neil Goldberg, MD

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1780625509

  SC

  Medicare reassignment Care Compare group NPD
• Heidi Jon Hartman, D.O.

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1629202866
  Medicare reassignment Care Compare group NPD
• George John Hatsios, MD

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1770566515
  Medicare reassignment Care Compare group NPD
• Richard S Herring, MD

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1164609731
  Medicare reassignment Care Compare group NPD
• Stephen John Lostetter Jr., MD

  • Diagnostic Radiology Physician
  • Chapel Hill, NC
  • NPI 1356325161
  Medicare reassignment Care Compare group NPD
• Leonor Lourido, FNP

  • Family Nurse Practitioner
  • Belmont, NC
  • NPI 1326476540
  Medicare reassignment Care Compare group NPD
• Mark William Memolo, MD

  • Diagnostic Radiology Physician
  • Gastonia, NC
  • NPI 1386627115
  Medicare reassignment Care Compare group NPD
• Robert William Miller, MD

  • Vascular & Interventional Radiology Physician
  • Gastonia, NC
  • NPI 1306821814

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1356324487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745431",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303745431",
            "telephone_number": "843-449-5360",
            "fax_number": "706-653-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SUMMIT CROSSING PL",
            "address_2": "STE 106",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542176",
            "telephone_number": "704-867-8021",
            "fax_number": "704-864-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON RADIOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "JAX",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "704-867-8021"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0067971",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901618",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NC",
            "identifier": "01618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC8346",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "8381530",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "1702",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E01618",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gaston Neurological, PLLC
• Gaston Oral & Maxillofacial Surgery
• Gaston Pharmacy LLC
• Gaston Primary Care PLLC
• Gaston Radiology
• Gaston Rehab Associates, Inc
• Gaston Residential Services, Icf/Mr, Inc.
• Gaston Residential Services, Icf/Mr, Inc.
• Gaston Residential Services, Icf/Mr, Inc.
• Gaston Residential Services, Inc.

• Diagnostic Radiology Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Diagnostic Radiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.