Organization Active NPI

Radiology Associates of Macon PC

  • Diagnostic Radiology Physician
  • Macon, GA
National Provider Identifier
1679563035
Registry record updated Nov 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY ASSOCIATES OF MACON PC
Practice address
770 Pine St Ste 290
Attn: Radiology Department
Macon, GA 31201-7516
Phone
(478) 743-1458
Fax
(478) 755-1332
NPI assigned
Oct 26, 2005
Last updated
Nov 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2012

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

Authorized official

Name
Mark E Grossnickle, M.D.NPI 1942281076
Title
President
Phone
(478) 743-1458

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 Primary

Addresses

Primary practice location

770 Pine St Ste 290
Attn: Radiology Department
Macon, GA 31201-7516

Mailing address

770 Pine St Ste 290
Attn: Radiology Department
Macon, GA 31201-7516
Phone (478) 743-1458

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX, CT, MO, FL, CA, CO, TN, NV, MA, AZ, OR, SC, VA, MD, NH, OH, AL, DC, IL, GU, MS, PA, HI, SD, NJ26 enrollments

Enrollment records 26

Enrollment IDStateProvider typePAC IDDetails
O20040317001131 GA Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 42 practitioners
Practice locations: Warner Robins, GA; Valdosta, GA; Savannah, GA; Richmond Hill, GA; Milledgeville, GA; Macon, GA; Alpharetta, GA; Atlanta, GA…
O20150603000905 TX Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 3 practitioners
Practice locations: Dickinson, TX; North Richland Hills, TX; San Antonio, TX
O20150710000948 CT Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Canton, CT; Shelton, CT
O20150715001838 MO Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Louis, MO
O20150803002126 FL Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 4 practitioners
Practice locations: West Palm Beach, FL; Sarasota, FL; Palm City, FL; Lakewood Ranch, FL; Hollywood, FL; Fort Lauderdale, FL
O20150806010067 CA Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 3 practitioners
Practice locations: Agoura Hills, CA; Irvine, CA; San Diego, CA
O20150921001014 CO Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 8 practitioners
Practice locations: Denver, CO; Littleton, CO; Fort Collins, CO; Colorado Springs, CO; Brighton, CO; Aurora, CO
O20151001000025 TN Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 3 practitioners
Practice locations: Kingsport, TN; Signal Mountain, TN; Brentwood, TN
O20160129001478 NV Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV
O20160622001912 MA Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Arlington, MA; Boston, MA
O20190425001106 AZ Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 3 practitioners
Practice locations: Peoria, AZ; Tucson, AZ; Scottsdale, AZ
O20190425001255 OR Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Eugene, OR; Medford, OR
O20190430002114 SC Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Camden, SC; Greenville, SC; Myrtle Beach, SC
O20190430002565 VA Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 3 practitioners
Practice locations: Virginia Beach, VA; Gainesville, VA; Ashburn, VA
O20190515002230 MD Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Berlin, MD
O20190613002076 NH Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Raymond, NH
O20200127000880 OH Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Goshen, OH
O20200310001406 AL Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Gadsden, AL
O20210713002527 DC Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Reston, VA; Vienna, VA
O20210716000693 IL Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Oak Brook, IL; Port Barrington, IL
O20230413002486 GU Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Chalan Pago, GU
O20230518002481 MS Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Madison, MS
O20230912003586 PA Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: New Kensington, PA
O20230914002430 HI Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 2 practitioners
Practice locations: Kailua, HI; Kapolei, HI
O20231130001505 SD Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Spearfish, SD
O20240604001047 NJ Part B Supplier - Clinic/Group Practice 7113817701 Receives reassigned benefits from 1 practitioner
Practice locations: Denville, NJ

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

8101 E Lowry Blvd
Lowry, CO 80230
Phone (303) 366-5656

1946 Tyler St
Ste 14
Hollywood, FL 33020
Phone (754) 210-5359

114 Sutherlin Dr
Ste R
Warner Robins, GA 31088
Phone (478) 287-6353

Practitioners & affiliated clinicians

Practitioners 207

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.

View all 207

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352160000000",
    "number": "1679563035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 PINE ST STE 290",
            "address_2": "ATTN: RADIOLOGY DEPARTMENT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312017516",
            "telephone_number": "478-743-1458",
            "fax_number": "478-755-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 PINE ST STE 290",
            "address_2": "ATTN: RADIOLOGY DEPARTMENT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312017516",
            "telephone_number": "478-743-1458",
            "fax_number": "478-755-1332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY ASSOCIATES OF MACON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2012-11-06",
        "status": "A",
        "authorized_official_last_name": "GROSSNICKLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-743-1458",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2012; 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.