NPIMap

Organization Active NPI

Cavalier Mobile Xray Co

Doing business as All-Stat Portable OH

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Youngstown, OH
National Provider Identifier
1669424743
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
License
R2377049 Issued in OH
Legal business name
CAVALIER MOBILE XRAY CO
Doing business as
All-Stat Portable OH
Practice address
590 E Western Reserve Rd
Unit 10D
Youngstown, OH 44514-3354
Phone
(330) 726-0202
Fax
(330) 726-0270
NPI assigned
May 16, 2006
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
ALL-STAT PORTABLE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

Name
Etai Sooliman
Title
Ceo
Phone
(224) 337-1199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X R2377049 OH Primary

Addresses

Primary practice location

590 E Western Reserve Rd
Unit 10D
Youngstown, OH 44514-3354

Mailing address

8235 Christiana Ave
Skokie, IL 60076-2910
Phone (224) 337-1197

Other identifiers 1

IdentifierTypeStateIssuer
0783728MedicaidOH

Other names 1

  • All-Stat Portable OH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080618000005 OH Part B Supplier - Portable X-Ray Supplier 3678462827 Practice locations: Youngstown, OH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Cavalier Mobile X-Ray C3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

8235 Christiana Ave
Skokie, IL 60076
Phone (224) 337-1000

Practitioners & affiliated clinicians

Practitioners 9

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": "1677110400000",
    "number": "1669424743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8235 CHRISTIANA AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762910",
            "telephone_number": "224-337-1197",
            "fax_number": "330-726-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 E WESTERN RESERVE RD",
            "address_2": "UNIT 10D",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143354",
            "telephone_number": "330-726-0202",
            "fax_number": "330-726-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAVALIER MOBILE XRAY CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALL-STAT PORTABLE, LLC",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "SOOLIMAN",
        "authorized_official_first_name": "ETAI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "224-337-1199"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "OH",
            "license": "R2377049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0783728",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "All-Stat Portable OH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; 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.