NPIMap

Organization Active NPI

Main Street Radiology at Bayside LLC

  • Diagnostic Radiology Physician
  • Bayside, NY
National Provider Identifier
1598852469
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MAIN STREET RADIOLOGY AT BAYSIDE LLC
Practice address
4401 Francis Lewis Blvd
Bayside, NY 11361-3002
Phone
(718) 428-1500
Fax
(718) 352-0292
NPI assigned
Oct 10, 2006
Last updated
Nov 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Authorized official

Name
Dr. Ari Jonisch, M.D.NPI 1841466042
Title
Officer
Phone
(718) 428-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

4401 Francis Lewis Blvd
Bayside, NY 11361-3002

Mailing address

3211 Francis Lewis Blvd
Flushing, NY 11358-1922
Phone (718) 352-9850

Other identifiers 1

IdentifierTypeStateIssuer
02217256MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040428001019 NY Part B Supplier - Clinic/Group Practice 5395732671 Receives reassigned benefits from 69 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20181029000570 CT Part B Supplier - Clinic/Group Practice 5395732671 Receives reassigned benefits from 4 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ridgefield, CT; Weston, CT; Greenwich, CT

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Main Street Radiology at Bayside LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1598852469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 FRANCIS LEWIS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581922",
            "telephone_number": "718-352-9850",
            "fax_number": "718-352-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 FRANCIS LEWIS BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613002",
            "telephone_number": "718-428-1500",
            "fax_number": "718-352-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET RADIOLOGY AT BAYSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "JONISCH",
        "authorized_official_first_name": "ARI",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "718-428-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02217256",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.