NPIMap

Organization Active NPI

Penrad Imaging LLC

  • Radiology Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1538760962
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
PENRAD IMAGING LLC
Practice address
6011 E Woodmen Rd Ste 10
Colorado Springs, CO 80923-2603
Phone
(719) 593-1799
Fax
(719) 265-3794
NPI assigned
Nov 3, 2020
Last updated
Nov 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Authorized official

Name
Derek Scott Bergeson, MD
Title
Radiologist
Phone
(719) 593-1799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

6011 E Woodmen Rd Ste 10
Colorado Springs, CO 80923-2603

Mailing address

PO Box 2989
Colorado Springs, CO 80901-2989
Phone (719) 593-1799

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D1090667Penrad Imaging at Sisters Grove Pavilion6011 E Woodmen Rd, Ste 10, Colorado Springs, CO 80923Certificate of waiverOct 15, 2026

National Provider Directory

National Provider Directory
Tax ID family
Penrad Imaging LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6011 E Woodmen Rd
Ste 10
Colorado Springs, CO 80923

NPI Registry JSON

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

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1538760962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2989",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809012989",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 E WOODMEN RD STE 10",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809232603",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENRAD IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "719-593-1799",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.