NPIMap

Organization Active NPI

Kettering Radiologist Imaging Center

  • Diagnostic Radiology Physician
  • Kettering, OH
National Provider Identifier
1720037534
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
KETTERING RADIOLOGIST IMAGING CENTER
Practice address
540 Lincoln Park Blvd
Suite 100
Kettering, OH 45429-6401
Phone
(937) 439-7861
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Ronald J Fadell, MDNPI 1912957796
Title
President
Phone
(937) 439-7861

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: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

540 Lincoln Park Blvd
Suite 100
Kettering, OH 45429-6401

Mailing address

PO Box 713082
Columbus, OH 43271-3082
Phone (614) 430-5707

Other identifiers 3

IdentifierTypeStateIssuer
000000018662OtherANTHEM
0604144MedicaidOH
CK1062OtherMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

2600 Far Hills Ave
Ste 118
Oakwood, OH 45419

27 S Allison
Xenia, OH 45385
Phone (513) 439-7855

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1720037534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713082",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432713082",
            "telephone_number": "614-430-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 LINCOLN PARK BLVD",
            "address_2": "SUITE 100",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454296401",
            "telephone_number": "937-439-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTERING RADIOLOGIST IMAGING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "FADELL",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-439-7861",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000018662",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0604144",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CK1062",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.