NPIMap

Organization Active NPI

Advanced Molecular Pet Imaging LLC

  • Physiological Laboratory
  • Las Vegas, NV
National Provider Identifier
1497360648
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
ADVANCED MOLECULAR PET IMAGING LLC
Practice address
5785 S Fort Apache Rd
Las Vegas, NV 89148-5659
Phone
(725) 258-6793
Fax
(725) 258-6794
NPI assigned
Sep 14, 2020
Last updated
Sep 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
James Ballow
Title
Authorized Official
Phone
(725) 258-6793

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

5785 S Fort Apache Rd
Las Vegas, NV 89148-5659

Mailing address

4200 W Russell Rd Ste 110
Las Vegas, NV 89118-2365
Phone (725) 258-6793

Other practice location 1

1648 Highway 95
Bullhead City, AZ 86442-7906
Phone (725) 258-6793

Other practice location 2

890 Airway Ave
Kingman, AZ 86409-3588
Phone (725) 258-6793

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220413001960 NV Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8820484181 Practice locations: Las Vegas, NV
O20230621000959 AZ Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8820484181 Practice locations: Kingman, AZ

National Provider Directory

National Provider Directory

Locations

4200 W Russell Rd
Ste 110
Las Vegas, NV 89118

801 S Rancho Dr
Ste A2
Las Vegas, NV 89106
Phone (702) 483-3630

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1497360648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 W RUSSELL RD STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891182365",
            "telephone_number": "725-258-6793",
            "fax_number": "725-258-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5785 S FORT APACHE RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891485659",
            "telephone_number": "725-258-6793",
            "fax_number": "725-258-6794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1648 Highway 95",
            "address_purpose": "LOCATION",
            "city": "Bullhead City",
            "state": "AZ",
            "postal_code": "864427906",
            "country_code": "US",
            "telephone_number": "725-258-6793",
            "fax_number": "725-258-6794",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "890 Airway Ave",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864093588",
            "country_code": "US",
            "telephone_number": "725-258-6793",
            "fax_number": "725-258-6794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED MOLECULAR PET IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "BALLOW",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "725-258-6793"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.