Active NPI
Frederick J Dahl, R.R.A. (ARRT)(R) RPA
- Radiology Practitioner Assistant
- Tupelo, MS
National Provider Identifier
1548291354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- RA00005
- Practice address
- 830 S Gloster St
Tupelo, MS 38801-4996 - Phone
- (662) 377-5232
- NPI assigned
- Jul 6, 2006
- Last updated
- Jan 29, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 09125 | MA | MD | Radiology Practitioner Assistant |
| RA00005 | MS | MD | Radiology Practitioner Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Mississippi Medical Center | Current | Accepting new patients |
Locations
830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136
Interoperability endpoints
- 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.
-
- General Acute Care Hospital
- Tupelo, MS
- NPI 1376969683
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.