NPIMap

Organization Active NPI

Midwest Radiology Outpatient Imaging, LLC

  • Diagnostic Radiology Physician
  • Saint Paul, MN
National Provider Identifier
1720059264
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MIDWEST RADIOLOGY OUTPATIENT IMAGING, LLC
Doing business as
Midwest Radiology Outpatient Imaging, LLC
Practice address
250 Thompson St
Saint Paul, MN 55102-2370
Phone
(651) 292-2000
NPI assigned
Feb 1, 2006
Last updated
Apr 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
See Yang
Title
Credentialing Manager
Phone
(651) 292-2013

Specialties & licenses 1

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

Addresses

Primary practice location

250 Thompson St
Saint Paul, MN 55102-2370

Mailing address

2355 Hwy 36 W.
Ste. 100
Roseville, MN 55113-3905
Phone (651) 292-2000

Other identifiers 1

IdentifierTypeStateIssuer
485512400MedicaidMN

Other names 1

  • Midwest Radiology Outpatient Imaging, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000119 MN Part B Supplier - Clinic/Group Practice 3870495591 Receives reassigned benefits from 215 practitioners
Practice locations: Burnsville, MN; Edina, MN; Saint Paul, MN

National Provider Directory

National Provider Directory

Member organizations 1

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

Locations

3130 Cleveland Ave N
Arden Hills, MN 55112
Phone (612) 624-6644

11225 Ulysses St NE
Ste 110
Blaine, MN 55434
Phone (763) 795-1607

1185 Town Centre Dr
Ste 145
Eagan, MN 55123
Phone (651) 797-6880

8650 Hudson Blvd N
Ste 130
Lake Elmo, MN 55042
Phone (651) 730-4145

1723 Beam Ave
#A
Maplewood, MN 55109
Phone (651) 747-4500

8990 Springbrook Dr NW
Ste 125
Minneapolis, MN 55433
Phone (763) 786-9460

3050 Centre Pointe Dr
Ste 800
Roseville, MN 55113
Phone (651) 631-0210

166 4th St E
Ste 100
Saint Paul, MN 55101

Practitioners & affiliated clinicians

Practitioners 268

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 268

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1720059264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HWY 36 W.",
            "address_2": "STE. 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 THOMPSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022370",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST RADIOLOGY OUTPATIENT IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "SEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "651-292-2013"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "485512400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Radiology Outpatient Imaging, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.