NPIMap

Organization Active NPI

Ernst Radiology Clinic, Inc

  • Diagnostic Radiology Physician
  • Mount Vernon, IL
National Provider Identifier
1699425462
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ERNST RADIOLOGY CLINIC, INC
Practice address
1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Phone
(618) 242-4600
NPI assigned
Mar 25, 2022
Organization subpart
Yes
Parent organization
ERNST RADIOLOGY CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Dr. Matthew W Stadnyk, MDNPI 1750313094
Title
President
Phone
(314) 308-1700

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 PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1 Good Samaritan Way
Mount Vernon, IL 62864-2402

Mailing address

12255 De Paul Dr Ste 737
Bridgeton, MO 63044-2530
Phone (314) 853-0865

Other practice location 1

400 N Pleasant Ave
Centralia, IL 62801-3056
Phone (618) 436-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO, AZ3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20220504000429 IL Part B Supplier - Clinic/Group Practice 2264829639 Receives reassigned benefits from 19 practitioners
Practice locations: Centralia, IL; Columbia, IL; Mount Vernon, IL
O20220602002306 MO Part B Supplier - Clinic/Group Practice 2264829639 Receives reassigned benefits from 19 practitioners
Practice locations: Mexico, MO; Jefferson City, MO; Fenton, MO; Bridgeton, MO
O20240813001357 AZ Part B Supplier - Clinic/Group Practice 2264829639 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory
Part of
The Ernst Radio Clinic Inc

Locations

12255 De Paul Dr
Ste 737
Bridgeton, MO 63044

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1699425462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR STE 737",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442530",
            "telephone_number": "314-853-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOOD SAMARITAN WAY",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642402",
            "telephone_number": "618-242-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Pleasant Ave",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "IL",
            "postal_code": "628013056",
            "country_code": "US",
            "telephone_number": "618-436-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ERNST RADIOLOGY CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ERNST RADIOLOGY CLINIC, INC",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "STADNYK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-308-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.