Individual provider Active NPI

Frederick J Dahl, R.R.A. (ARRT)(R) RPA

  • Radiology Practitioner Assistant
  • Tupelo, MS
National Provider Identifier
1548291354
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Practitioner AssistantTaxonomy code 243U00000X
License
RA00005 Issued in MS
Practice address
830 S Gloster St
Tupelo, MS 38801-4996
Phone
(662) 377-5232
NPI assigned
Jul 6, 2006
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular-Interventional Technology Radiologic Technologist 2471V0106X 09125 MA
Radiology Practitioner Assistant 243U00000X 09125 MA
Radiology Practitioner Assistant 243U00000X RA00005 MS Primary

Addresses

Primary practice location

830 S Gloster St
Tupelo, MS 38801-4996

Mailing address

111 Jean Jane LN
Tupelo, MS 38804-9113
Phone (603) 661-5485

Other practice location 1

620 Crossover Rd
Tupelo, MS 38801-4944
Phone (662) 842-1758

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
09125MAMDRadiology Practitioner Assistant
RA00005MSMDRadiology Practitioner Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Current Accepting new patients

Locations

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Interoperability endpoints

  • Direct secure messaging: frederickdahl@nmhs.medalliesdirect.net

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1548291354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 JEAN JANE LN",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388049113",
            "telephone_number": "603-661-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014996",
            "telephone_number": "662-377-5232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 Crossover Rd",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388014944",
            "country_code": "US",
            "telephone_number": "662-842-1758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAHL",
        "first_name": "FREDERICK",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "R.R.A. (ARRT)(R) RPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471V0106X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": "MA",
            "license": "09125",
            "primary": false
        },
        {
            "code": "243U00000X",
            "taxonomy_group": "",
            "desc": "Radiology Practitioner Assistant",
            "state": "MA",
            "license": "09125",
            "primary": false
        },
        {
            "code": "243U00000X",
            "taxonomy_group": "",
            "desc": "Radiology Practitioner Assistant",
            "state": "MS",
            "license": "RA00005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.