NPIMap

Organization Active NPI

Advanced Imaging Specialists, LLC

  • Diagnostic Radiology Physician
  • Hartford, CT
National Provider Identifier
1689429078
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ADVANCED IMAGING SPECIALISTS, LLC
Practice address
114 Woodland St
Hartford, CT 06105-1208
Phone
(203) 426-3002
NPI assigned
Apr 19, 2024
Last updated
May 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Authorized official

Name
Kirt Frederickson, MD
Title
President
Phone
(203) 426-3002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

114 Woodland St
Hartford, CT 06105-1208

Mailing address

2 Riverview Dr Ste 104
Danbury, CT 06810-6268
Phone (203) 426-3002

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240808003398 CT Part B Supplier - Clinic/Group Practice 9234676164 Receives reassigned benefits from 60 practitioners
Practice locations: Hartford, CT; Waterbury, CT; Stafford Springs, CT; Enfield, CT

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1713484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1689429078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 RIVERVIEW DR STE 104",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106268",
            "telephone_number": "203-426-3002",
            "fax_number": "203-917-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "203-426-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED IMAGING SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-19",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "FREDERICKSON",
        "authorized_official_first_name": "KIRT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-426-3002",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.