Advanced Mobile Imaging, LLC

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

003259 Issued in CT

Legal business name

ADVANCED MOBILE IMAGING, LLC

Practice address

75 New Haven Ave
Milford, CT 06460-4854

Phone

(203) 878-6768

Fax

(203) 878-6087

NPI assigned

Jul 10, 2006

Last updated

Aug 31, 2016By 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

Mr. Brian F Elzin, B.S., RDMS, RT (R)

Title

Managing Member

Phone

(203) 878-6768

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396779237. Details of each certification follow.

• CCN 07X0009829 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 07X0009829

Legal name

ADVANCED MOBILE IMAGING, LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Apr 26, 2007

Last certification

Aug 19, 2016

Ownership / control type

Individual

Facility address

75 New Haven Avenue
Milford, CT 06460

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1396779237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064600416",
            "telephone_number": "203-878-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 NEW HAVEN AVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064604854",
            "telephone_number": "203-878-6768",
            "fax_number": "203-878-6087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MOBILE IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "ELZIN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "203-878-6768",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S., RDMS, RT (R)"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CT",
            "license": "81408",
            "primary": false
        },
        {
            "code": "2471B0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Bone Densitometry",
            "state": "CT",
            "license": "003259",
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Other",
            "state": "CT",
            "license": "003259",
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "CT",
            "license": "003259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Milford, CT
• Providers in Milford, CT by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.