Glenn P Moradian, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

PT11018 Issued in ND

Practice address

1301 15TH Ave W
Williston, ND 58801-3821

Phone

(701) 774-7401

NPI assigned

Jul 8, 2005

Last updated

Oct 17, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Diagnostic Radiology PC

  • Diagnostic Radiology Physician
  • Williston, ND
  • NPI 1922006519
  NPD (past) Authorized official
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)
• JCMH Healthcare Corporation

  dba JCMH Scanner

  • Radiology Clinic/Center
  • Altus, OK
  • NPI 1255388641
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Diagnostic Radiology

  NPD (past)
• Teton Open MRI of Pocatello, LLC

  • Radiology Clinic/Center
  • Pocatello, ID
  • NPI 1194798397
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224201600000",
    "number": "1356349955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2537",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588022537",
            "telephone_number": "866-338-6472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORADIAN",
        "first_name": "GLENN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2008-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "PT11018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IDAHO",
            "identifier": "B4059",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IDAHO",
            "identifier": "B5651",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NO",
            "identifier": "P00203248",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS INDIVIDUAL PIN NUMBER",
            "identifier": "000010149530",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IDAHO",
            "identifier": "74070",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804043200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15042",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Renee Montgomery, BA/LAC
• Moor Mind Matters LLC
• McKenzie Larae Moor, PMHNP
• Chelsey Rae Moore, MSW,LSW
• Jason Dewitt Moore, DC
• Alesha M Morken, LSW
• Angele Morris
• Christina Marie Morris
• Kelsey Muller
• James Eric Mullinax

• Diagnostic Radiology Physician in Williston, ND
• Providers in Williston, ND by specialty
• Diagnostic Radiology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; 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.