Pavilion Imaging, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PAVILION IMAGING, LLC

Practice address

29201 Telegraph Rd Ste L-01
Southfield, MI 48034-1301

Phone

(248) 304-7775

Fax

(248) 918-2033

NPI assigned

Dec 23, 2014

Organization subpart

Yes

Parent organization

PHOENIX MEDICAL GROUP, PCAs reported in NPPES

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

Authorized official

Name

Mrs. Abbie Hill

Title

Administrator

Phone

(248) 304-7647

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Phoenix Medical Group PC4 organizations share this tax ID, including this one

Part of

Phoenix Medical Group PC

Other organizations with this tax ID 3

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

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  NPD tax ID
• Vital Sleep Center, PLLC

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  NPD tax ID

Locations

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

{
    "created_epoch": "1419292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1659769867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD",
            "address_2": "SUITE 450",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751331",
            "telephone_number": "248-304-7659",
            "fax_number": "248-423-4683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29201 TELEGRAPH RD STE L-01",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341301",
            "telephone_number": "248-304-7775",
            "fax_number": "248-918-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION IMAGING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOENIX MEDICAL GROUP, PC",
        "enumeration_date": "2014-12-23",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "ABBIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-304-7647",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306075551",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryann Paul, M.D
• Richard Paul, M.D.
• Sharon L Paul, LMSW
• Cindy Pavicic, B.S., D.P.M.
• Pavilion Family Practice PC
• Kaia Pawloski
• Andrew Jason Payne, MD
• Angela S. Payne, LLPC
• Robert Payne
• Jennifer Paynter

• Radiology Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Radiology Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.