NPIMap

Organization Active NPI

Bluegrass Regional Imaging LLC

  • Diagnostic Radiology Physician
  • Lexington, KY
National Provider Identifier
1669636486
Registry record updated Mar 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BLUEGRASS REGIONAL IMAGING LLC
Practice address
1401 Harrodsburg Rd
C45
Lexington, KY 40504-3751
Phone
(859) 276-2157
Fax
(859) 276-4938
NPI assigned
Jul 10, 2008
Last updated
Mar 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2026

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

Authorized official

Name
Dr. Jon K Kostelic, M.D.NPI 1700842275
Title
Member
Phone
(859) 219-0542

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
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1401 Harrodsburg Rd
C45
Lexington, KY 40504-3751

Mailing address

651 Perimeter Dr Ste 690
Lexington, KY 40517-4356
Phone (859) 219-0542

Other identifiers 2

IdentifierTypeStateIssuer
000000219100OtherKYANTHEM
65935207MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070925000553 KY Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 0143271098 Practice locations: Lexington, KY

Other NPIs with the same Medicare PAC ID 2

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

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
18D1088626Bluegrass Regional Imaging1401 Harrodsburg Road, Lexington, KY 40504Certificate of waiverAug 28, 2026

National Provider Directory

National Provider Directory
Tax ID family
Bluegrass Regional Imaging LLC3 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1401 Harrodsburg Rd
Ste C45
Lexington, KY 40504
Phone (859) 276-2157

Practitioners & affiliated clinicians

Practitioners 12

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": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774569600000",
    "number": "1669636486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 PERIMETER DR STE 690",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405174356",
            "telephone_number": "859-219-0542",
            "fax_number": "859-219-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 HARRODSBURG RD",
            "address_2": "C45",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405043751",
            "telephone_number": "859-276-2157",
            "fax_number": "859-276-4938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS REGIONAL IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A",
        "authorized_official_last_name": "KOSTELIC",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "859-219-0542",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000219100",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65935207",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; 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.