Active NPI
Advanced Imaging Center, LLC
- Radiology Clinic/Center
- Moline, IL
National Provider Identifier
1619964467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Clinic/Center
- Legal business name
- ADVANCED IMAGING CENTER, LLC
- Practice address
- 615 Valley View Dr Ste 101
Moline, IL 61265-6150 - Phone
- (815) 315-1718
- NPI assigned
- Oct 5, 2005
- Last updated
- Mar 25, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karen Vaughn
- Title
- Ao
- Phone
- (629) 317-1465
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiology Clinic/Center | 261QR0200X | NU | Primary |
Addresses
Primary practice location
615 Valley View Dr Ste 101
Moline, IL 61265-6150
Mailing address
PO Box 4688
Rock Island, IL 61204-4688
Phone (309) 762-1072
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060817000201 | IL | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 4082650239 | Practice locations: Moline, IL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2188279 | Advanced Imaging Center L L C | Certificate of waiver | Jul 14, 2028 |
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Trinity Work Fitness
- General Practice Physician
- Moline, IL
- NPI 1770699902
Member Of
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1774396800000",
"number": "1619964467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4688",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612044688",
"telephone_number": "309-762-1072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 VALLEY VIEW DR STE 101",
"city": "MOLINE",
"state": "IL",
"postal_code": "612656150",
"telephone_number": "815-315-1718"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED IMAGING CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-05",
"last_updated": "2026-03-25",
"certification_date": "2026-03-25",
"status": "A",
"authorized_official_last_name": "VAUGHN",
"authorized_official_first_name": "KAREN",
"authorized_official_title_or_position": "AO",
"authorized_official_telephone_number": "629-317-1465"
},
"taxonomies": [
{
"code": "261QR0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Moline, IL
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- Advanced Foot & Ankle Center Inc
- Advanced Hearing Aid Service
- Advanced Physical Therapy Services LTD (Advanced Rehab & Sports Medicine)
- Sophie Adrianna Agbayani, LSW
- Vikram Agrawal, MD
- Anis Ahmad, M.D., F.R.C.P.
- Naurin Ehsan Ahmad, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.