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Organization Active NPI

Bloomington Radiology S C

  • Diagnostic Radiology Physician
  • Normal, IL
National Provider Identifier
1700831773
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
042001755 Issued in IL
Legal business name
BLOOMINGTON RADIOLOGY S C
Practice address
2200 Fort Jesse Rd
Suite 280
Normal, IL 61761-6286
Phone
(309) 452-1788
Fax
(309) 862-1302
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Ajay Malpani, M.D.
Title
President
Phone
(309) 452-1788

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085B0100X 042001755 IL
Neuroradiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0700X 042001755 IL
Nuclear Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0904X 042001755 IL
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X 042001755 IL Primary
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X 042001755 IL

Addresses

Primary practice location

2200 Fort Jesse Rd
Suite 280
Normal, IL 61761-6286

Mailing address

PO Box 3668
Bloomington, IL 61702-3668
Phone (309) 452-1788

National Provider Directory

National Provider Directory

Locations

1404 Eastland Dr
Ste 104
Bloomington, IL 61701
Phone (309) 604-9690

3024 E Empire St
Bloomington, IL 61704
Phone (309) 556-7500

308 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-5050

2200 Jacobssen Dr
Normal, IL 61761
Phone (309) 451-1121

200 S Towanda Ave
Normal, IL 61761
Phone (309) 452-7445

2200 Fort Jesse Rd
Ste 280
Normal, IL 61761
Phone (800) 755-9195

1200 Franklin Ave
Normal, IL 61761
Phone (309) 268-2182

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1700831773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3668",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617023668",
            "telephone_number": "309-452-1788",
            "fax_number": "309-862-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD",
            "address_2": "SUITE 280",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616286",
            "telephone_number": "309-452-1788",
            "fax_number": "309-862-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON RADIOLOGY S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "MALPANI",
        "authorized_official_first_name": "AJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-452-1788",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": "IL",
            "license": "042001755",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": "IL",
            "license": "042001755",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": "IL",
            "license": "042001755",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "042001755",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "042001755",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.