NPIMap

Organization Active NPI

Providence Health Services, Inc

Doing business as The Providence Diagnostic Imaging Center

  • Physiological Laboratory
  • Washington, DC
National Provider Identifier
1598313595
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Doing business as
The Providence Diagnostic Imaging Center
Practice address
1150 Varnum St NE Ste 1
Washington, DC 20017-2104
Phone
(202) 854-7560
Fax
(202) 854-7951
NPI assigned
Sep 3, 2019
Last updated
May 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Authorized official

Name
Michael Dunwell
Title
Coord Credentialing
Phone
(202) 854-4069

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X
Mammography Clinic/Center 261QR0206X
Physiological Laboratory 293D00000X Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X

Addresses

Primary practice location

1150 Varnum St NE Ste 1
Washington, DC 20017-2104

Mailing address

1150 Varnum St NE
Washington, DC 20017-2180
Phone (202) 854-4069

Other names 1

  • The Providence Diagnostic Imaging Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211122001025 DC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4385541622 Practice locations: Washington, DC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Providence Hospital23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

1140 Varnum St NE
Ste 100
Washington, DC 20017
Phone (202) 854-7623

1150 Varnum St NE
#424
Washington, DC 20017

1150 Varnum St NE
Ste 1
Washington, DC 20017
Phone (202) 854-7560

1160 Varnum St NE
Ste 21
Washington, DC 20017
Phone (202) 525-1448

1160 Varnum St NE
Ste 306
Washington, DC 20017
Phone (202) 269-2011

14300 Gallant Fox Ln
Ste 224
Bowie, MD 20715
Phone (301) 262-8291

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1598313595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172180",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE STE 1",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-7560",
            "fax_number": "202-854-7951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-03",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A",
        "authorized_official_last_name": "DUNWELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "COORD CREDENTIALING",
        "authorized_official_telephone_number": "202-854-4069"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Providence Diagnostic Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.