NPIMap

Organization Active NPI

Innovative Radiology, LLC

  • Diagnostic Radiology Physician
  • West Des Moines, IA
National Provider Identifier
1700486776
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
INNOVATIVE RADIOLOGY, LLC
Practice address
7601 Office Plaza Drive N
Unit 115
West Des Moines, IA 50266-5026
Phone
(515) 222-0550
Fax
(515) 222-0544
NPI assigned
Oct 29, 2020
Last updated
Apr 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
John Tentinger, MDNPI 1801881933
Title
President
Phone
(515) 554-2887

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

7601 Office Plaza Drive N
Unit 115
West Des Moines, IA 50266-5026

Mailing address

PO Box 2660
Waterloo, IA 50704-2660
Phone (800) 728-3044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, WI, SC, MN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20231129003502 IA Part B Supplier - Clinic/Group Practice 0648503284 Receives reassigned benefits from 18 practitioners
Practice locations: West Des Moines, IA
O20260512003052 WI Part B Supplier - Clinic/Group Practice 0648503284 Receives reassigned benefits from 1 practitioner
Practice locations: Menasha, WI
O20260529000404 SC Part B Supplier - Clinic/Group Practice 0648503284 Receives reassigned benefits from 1 practitioner
Practice locations: Piedmont, SC
O20260602000429 MN Part B Supplier - Clinic/Group Practice 0648503284 Receives reassigned benefits from 1 practitioner
Practice locations: North Oaks, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2343355Innovative Radiology7601 Office Plaza Dr Ste 115, West Des Moines, IA 50266Certificate of waiverMay 4, 2028

National Provider Directory

National Provider Directory

Member organizations 1

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

  • Ramic Des Moines, LLC

    dba Alliance HealthCare Radiology

    • Magnetic Resonance Imaging (MRI) Clinic/Center
    • West Des Moines, IA
    • NPI 1801081237

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1700486776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2660",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042660",
            "telephone_number": "800-728-3044",
            "fax_number": "319-260-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 OFFICE PLAZA DRIVE N",
            "address_2": "UNIT 115",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502665026",
            "telephone_number": "515-222-0550",
            "fax_number": "515-222-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE RADIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "TENTINGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-554-2887",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.