Organization Active NPI

Musculoskeletal Imaging and Interventional LLC

  • Vascular & Interventional Radiology Physician
  • Edmond, OK
National Provider Identifier
1629020995
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC
Practice address
1023 Waterwood Pkwy
Edmond, OK 73034-5324
Phone
(405) 601-2325
Fax
(405) 497-6074
NPI assigned
May 16, 2006
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Douglas P Beall, MDNPI 1992757181
Title
Chief of Services
Phone
(405) 601-2325

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

1023 Waterwood Pkwy
Edmond, OK 73034-5324

Mailing address

PO Box 1390
Oklahoma City, OK 73101-1390
Phone (405) 601-2325

Other identifiers 1

IdentifierTypeStateIssuer
200069440BMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060601000083 OK Part B Supplier - Clinic/Group Practice 2466463617 Receives reassigned benefits from 1 practitioner
Practice locations: Edmond, OK

National Provider Directory

National Provider Directory
Tax ID family
Musculoskeletal Imaging and Interventional LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

105 S Bryant Ave
Ste 404K
Edmond, OK 73034

937 SW 89th St
Ofc For
Oklahoma City, OK 73139
Phone (405) 601-2325

Practitioners & affiliated clinicians

Practitioners 1

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": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1629020995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1390",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731011390",
            "telephone_number": "405-601-2325",
            "fax_number": "405-497-6074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 WATERWOOD PKWY",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730345324",
            "telephone_number": "405-601-2325",
            "fax_number": "405-497-6074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "BEALL",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF OF SERVICES",
        "authorized_official_telephone_number": "405-601-2325",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200069440B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; 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.