Forest City Diagnostic Imaging LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

FOREST CITY DIAGNOSTIC IMAGING LLC

Practice address

735 N Perryville Rd
Rockford, IL 61107-6200

Phone

(815) 398-1300

Fax

(815) 398-3797

NPI assigned

Aug 31, 2006

Last updated

Jun 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Patricia A Wabick

Title

Manager

Phone

(708) 675-1500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Rockford Open MRI, L.L.C. Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Indiana Regional P E T and Imaging Center, LLC

  • Radiology Clinic/Center
  • Merrillville, IN
  • NPI 1750471470

  Member Of

  NPD member

Locations

Practitioners 6

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.

• Mary Christine Baldauf, MD

  • Pediatric Critical Care Medicine Physician
  • Oak Lawn, IL
  • NPI 1447271911
  NPD
• Adel Abdalla, M.D.

  • Diagnostic Radiology Physician
  • Orlando, FL
  • NPI 1497702542
  NPD
• Lukas Cornelius Blignaut, MD

  • Diagnostic Radiology Physician
  • Columbia, MO
  • NPI 1558397976
  NPD
• Farah Ian Brown, MD

  • Diagnostic Radiology Physician
  • Richmond, KY
  • NPI 1871595736
  NPD
• Philip B. McDonald, M.D.

  • Diagnostic Radiology Physician
  • Miami, FL
  • NPI 1649411422
  NPD
• Kim-Doan Katrina Nguyen, M.D.

  • Pediatric Gastroenterology Physician
  • Stamford, CT
  • NPI 1235371386
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1386755700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076200",
            "telephone_number": "815-398-1300",
            "fax_number": "815-398-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076200",
            "telephone_number": "815-398-1300",
            "fax_number": "815-398-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST CITY DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "WABICK",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-675-1500"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "10123287",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "470000357",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rockford Open MRI, L.L.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Rockford Open MRI, L.L.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jessica Ford, LCSW
• Candace Lee Fore
• Forest City Counseling, LLC
• Forest City Dental
• Forest City Dental PC
• Forest City Physical Therapy Limited Partnership
• Forest City Rehab and Nursing Center, LLC
• Forest View Counseling Services PLLC
• Form Orthotics & Prosthetics, PLLC
• Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA

• Radiology Clinic/Center in Rockford, IL
• Providers in Rockford, IL by specialty
• Radiology Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.