NPIMap

Organization Active NPI

Steward Pet Imaging, L.L.C.

  • Mobile Radiology Clinic/Center
  • Brockton, MA
National Provider Identifier
1679720379
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
License
4NNJ Issued in MA
Legal business name
STEWARD PET IMAGING, L.L.C.
Practice address
235 North Pearl Street
Brockton, MA 02301-1794
Phone
(877) 877-8455
Fax
(866) 927-0079
NPI assigned
Aug 25, 2008
Organization subpart
Yes
Parent organization
STEWARD PET IMAGING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Authorized official

Name
Mr. Robert E Guyon Jr.
Title
Coo
Phone
(617) 789-5047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Radiology Clinic/Center 261QR0208X 4NNJ MA Primary

Addresses

Primary practice location

235 North Pearl Street
Brockton, MA 02301-1794

Mailing address

800 Washington St
Norwood, MA 02062-3487
Phone (877) 877-8455

Other identifiers 1

IdentifierTypeStateIssuer
110073236GMedicaidMA

Other names 1

  • Steward PET Imaging, LLC at Good Samaritan Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041206000621 MA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7214831056 9 other NPIs on this enrollment
Practice locations: Norwood, MA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Steward Pet Imaging LLC

NPI Registry JSON

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1679720379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST",
            "city": "NORWOOD",
            "state": "MA",
            "postal_code": "020623487",
            "telephone_number": "877-877-8455",
            "fax_number": "866-927-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 NORTH PEARL STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011794",
            "telephone_number": "877-877-8455",
            "fax_number": "866-927-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWARD PET IMAGING, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEWARD PET IMAGING, LLC",
        "enumeration_date": "2008-08-25",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "GUYON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "617-789-5047",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "MA",
            "license": "4NNJ",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110073236G",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steward PET Imaging, LLC at Good Samaritan Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.