NPIMap

Organization Active NPI

Grapevine Imaging & Pain Management Center LLC

Doing business as Eclipse Imaging Pain Management Center-Grapevine

  • Diagnostic Radiology Physician
  • Grapevine, TX
National Provider Identifier
1639180797
Registry record updated May 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R25579 Issued in TX
Legal business name
GRAPEVINE IMAGING & PAIN MANAGEMENT CENTER LLC
Doing business as
Eclipse Imaging Pain Management Center-Grapevine
Practice address
2401 Ira E Woods
#600
Grapevine, TX 76051-8631
Phone
(817) 488-9991
Fax
(817) 488-9992
NPI assigned
Aug 11, 2006
Last updated
May 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2016

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

Authorized official

Name
Mr. Gail S. Mayfield
Title
Ceo/Managing Member
Phone
(817) 479-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R25579 TX Primary

Addresses

Primary practice location

2401 Ira E Woods
#600
Grapevine, TX 76051-8631

Mailing address

2401 Ira E Woods
#600
Grapevine, TX 76051-8631
Phone (817) 488-9991

Other identifiers 4

IdentifierTypeStateIssuer
303769901MedicaidTX
376985800OtherTXDOL
9676331OtherTXCIGNA
0119DCOtherTXBCBS

Other names 1

  • Eclipse Imaging Pain Management Center-Grapevine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050110000398 TX Part B Supplier - Clinic/Group Practice 9931157609 Receives reassigned benefits from 46 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2401 Ira E Woods Ave
Ste 600
Grapevine, TX 76051
Phone (817) 488-9991

Practitioners & affiliated clinicians

Practitioners 2

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": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1639180797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 IRA E WOODS",
            "address_2": "#600",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518631",
            "telephone_number": "817-488-9991",
            "fax_number": "817-488-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 IRA E WOODS",
            "address_2": "#600",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518631",
            "telephone_number": "817-488-9991",
            "fax_number": "817-488-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAPEVINE IMAGING & PAIN MANAGEMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2016-05-13",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO/MANAGING MEMBER",
        "authorized_official_telephone_number": "817-479-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R25579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303769901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL",
            "identifier": "376985800",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9676331",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0119DC",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eclipse Imaging Pain Management Center-Grapevine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grapevine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; 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.