NPIMap

Organization Active NPI

Midtown Medical Imaging - Alliance

  • Radiology Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1629527312
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MIDTOWN MEDICAL IMAGING - ALLIANCE
Practice address
9557 N. Beach St.
Suite 101
Fort Worth, TX 76244
Phone
(817) 768-5317
Fax
(817) 920-9992
NPI assigned
Sep 23, 2016
Last updated
Aug 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Authorized official

Name
Mr. Brad Scoble
Title
Owner/Managing Partner
Phone
(817) 768-5317

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

9557 N. Beach St.
Suite 101
Fort Worth, TX 76244

Mailing address

900 Jerome St
Suite 104
Fort Worth, TX 76104-3945

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170623001327 TX Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 6204104706 Practice locations: Fort Worth, TX

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
45D2126525Midtown Medical Imaging -Alliance, LLC9557 N Beach Street, Suite 101, Fort Worth, TX 76244Certificate of waiverFeb 27, 2027

National Provider Directory

National Provider Directory

Locations

9557 N Beach St
Ste 101
Fort Worth, TX 76244
Phone (817) 768-5317

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502755200000",
    "number": "1629527312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 JEROME ST",
            "address_2": "SUITE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9557 N. BEACH ST.",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76244",
            "telephone_number": "817-768-5317",
            "fax_number": "817-920-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWN MEDICAL IMAGING - ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-23",
        "last_updated": "2017-08-15",
        "status": "A",
        "authorized_official_last_name": "SCOBLE",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER/MANAGING PARTNER",
        "authorized_official_telephone_number": "817-768-5317",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; 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.