NPIMap

Organization Active NPI

Providence Diagnostic Imaging, Inc.

  • Diagnostic Radiology Physician
  • Springfield, MA
National Provider Identifier
1609978170
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PROVIDENCE DIAGNOSTIC IMAGING, INC.
Practice address
271 Carew St
Springfield, MA 01104-2377
Phone
(413) 748-9200
NPI assigned
Sep 3, 2006
Last updated
Jul 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Dr. Gregory E. Blackman, M.D.NPI 1811941032
Title
President
Phone
(413) 748-9200

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X
Neuroradiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0700X
Nuclear Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0904X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

271 Carew St
Springfield, MA 01104-2377

Mailing address

271 Carew St
Springfield, MA 01104-2377
Phone (413) 748-9200

Other identifiers 11

IdentifierTypeStateIssuer
102940700OtherUS DEPARTMENT OF LABOR
98133101OtherMANETWORK HEALTH
000000025268OtherMABMC HEALTHNET PLAN
755228OtherMATUFTS
003126358MedicaidCT
1601748OtherEVERCARE
774327OtherCONNECTICARE
9776559MedicaidMA
CA7920OtherRAILROAD MEDICARE
783230OtherMAAETNA/US HEALTHCARE
M16237OtherMABLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT, CA, TX, MT, NC, WA7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20040508000173 MA Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 28 practitioners
Practice locations: Amherst, MA; Belmont, MA; Holyoke, MA; Natick, MA; Northampton, MA; Springfield, MA
O20120821000823 CT Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 4 practitioners
Practice locations: West Hartford, CT; Stafford Springs, CT; Enfield, CT; Somers, CT; Avon, CT
O20190218002969 CA Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 3 practitioners
Practice locations: Coronado, CA; Oceanside, CA; Santa Barbara, CA
O20210831000229 TX Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 3 practitioners
Practice locations: Houston, TX; Spring, TX; Sugar Land, TX
O20231006000933 MT Part B Supplier - Clinic/Group Practice 1052300787 Practice locations: Butte, MT
O20231025002316 NC Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 2 practitioners
Practice locations: Winston Salem, NC; Winterville, NC
O20240123000089 WA Part B Supplier - Clinic/Group Practice 1052300787 Receives reassigned benefits from 6 practitioners
Practice locations: Bainbridge Island, WA; Bellingham, WA; Clyde Hill, WA; Kirkland, WA; Seattle, WA

National Provider Directory

National Provider Directory

Locations

495 Brickell Ave
Apt 5
Miami, FL 33131

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1609978170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 CAREW ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011042377",
            "telephone_number": "413-748-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 CAREW ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011042377",
            "telephone_number": "413-748-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE DIAGNOSTIC IMAGING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-03",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "BLACKMAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "413-748-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "102940700",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "98133101",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC HEALTHNET PLAN",
            "identifier": "000000025268",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "755228",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126358",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "1601748",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "774327",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9776559",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA7920",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/US HEALTHCARE",
            "identifier": "783230",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "M16237",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.