Organization Active NPI

Advanced Imaging Center, LLC

  • Radiology Clinic/Center
  • Moline, IL
National Provider Identifier
1619964467
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
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, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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)CodeLicenseStatePrimary
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 IDStateProvider typePAC IDDetails
O20060817000201 IL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4082650239 Practice locations: Moline, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2188279Advanced Imaging Center L L C615 Valley View Dr - Ste 101, Moline, IL 61265Certificate of waiverJul 14, 2028

National Provider Directory

National Provider Directory

Member of 2

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

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

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.

Verify at the official NPI Registry.