NPIMap

Organization Active NPI

Sira Imaging Center LLC

  • Diagnostic Radiology Physician
  • Bloomington, IN
National Provider Identifier
1558326124
Registry record updated Nov 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SIRA IMAGING CENTER LLC
Practice address
500 S Landmark Ave
Bloomington, IN 47403-3239
Phone
(812) 332-8242
Fax
(812) 333-7684
NPI assigned
Apr 18, 2006
Last updated
Nov 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2010

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

Authorized official

Name
Dr. Mark Bisesi, M.D.NPI 1346208253
Title
President
Phone
(812) 332-8242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

500 S Landmark Ave
Bloomington, IN 47403-3239

Mailing address

PO Box 4366
Bloomington, IN 47402-4366
Phone (812) 332-8242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, CO, FL, NV, AZ5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040327000005 IN Part B Supplier - Clinic/Group Practice 3274425996 Receives reassigned benefits from 25 practitioners
Practice locations: Bloomington, IN
O20210611000151 CO Part B Supplier - Clinic/Group Practice 3274425996 Receives reassigned benefits from 1 practitioner
Practice locations: Lakewood, CO
O20210916003093 FL Part B Supplier - Clinic/Group Practice 3274425996 Receives reassigned benefits from 1 practitioner
Practice locations: Hollywood, FL
O20220110001833 NV Part B Supplier - Clinic/Group Practice 3274425996 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV
O20230313000783 AZ Part B Supplier - Clinic/Group Practice 3274425996 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

500 S Landmark Ave
Bloomington, IN 47403
Phone (812) 333-7676

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1558326124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4366",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474024366",
            "telephone_number": "812-332-8242",
            "fax_number": "812-333-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-332-8242",
            "fax_number": "812-333-7684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIRA IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "BISESI",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-332-8242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.