Active NPI
Radiology Specialists of St Joseph PC
- Diagnostic Radiology Physician
- Saint Joseph, MO
National Provider Identifier
1679512701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- RADIOLOGY SPECIALISTS OF ST JOSEPH PC
- Practice address
- 5325 Faraon St
Saint Joseph, MO 64506-3488 - Phone
- (816) 271-6575
- Fax
- (816) 271-7644
- NPI assigned
- Jun 5, 2006
- Last updated
- Jul 21, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Bruns
- Title
- Administrator
- Phone
- (816) 271-6575
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
5325 Faraon St
Saint Joseph, MO 64506-3488
Mailing address
PO Box 8252
Saint Joseph, MO 64508-8252
Phone (816) 271-6575
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111294 | Other | KS | BCBS OF KS FOR KS LOCATIO |
| 470766 | Other | KS | BCBS OF KS FOR MO LOCATIO |
| CK7871 | Other | MO | RR MEDICARE |
| 509395802 | Medicaid | MO | |
| DG5299 | Other | KS | RR MEDICARE |
| 200400950A | Medicaid | KS | |
| 32212011 | Other | MO | BCBS KC MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO, KS, CA, MN, WA, TN, HI, UT
Enrollment records 8
National Provider Directory
National Provider DirectoryLocations
3906 Oakland Ave
Unit 8252
Saint Joseph, MO 64508
901 Heartland Rd
Ste 1800
Saint Joseph, MO 64506
Phone (816) 232-8877
Practitioners & affiliated clinicians
Practitioners 28
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.
-
- Diagnostic Radiology Physician
- Lake City, MN
- NPI 1548249246
-
- Diagnostic Radiology Physician
- Bristol, TN
- NPI 1336397124
-
- Diagnostic Radiology Physician
- Pittsburgh, PA
- NPI 1841619871
KS, MO
-
- Diagnostic Radiology Physician
- La Jolla, CA
- NPI 1528313624
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1405900800000",
"number": "1679512701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8252",
"city": "SAINT JOSEPH",
"state": "MO",
"postal_code": "645088252",
"telephone_number": "816-271-6575",
"fax_number": "816-271-7644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5325 FARAON ST",
"city": "SAINT JOSEPH",
"state": "MO",
"postal_code": "645063488",
"telephone_number": "816-271-6575",
"fax_number": "816-271-7644"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RADIOLOGY SPECIALISTS OF ST JOSEPH PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-05",
"last_updated": "2014-07-21",
"status": "A",
"authorized_official_last_name": "BRUNS",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "816-271-6575"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF KS FOR KS LOCATIO",
"identifier": "111294",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF KS FOR MO LOCATIO",
"identifier": "470766",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CK7871",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "509395802",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "DG5299",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200400950A",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS KC MO",
"identifier": "32212011",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.