Active NPI
Diaspora Radiology, SC
- Magnetic Resonance Imaging (MRI) Clinic/Center
- Northbrook, IL
National Provider Identifier
1730652017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Magnetic Resonance Imaging (MRI) Clinic/Center
- Legal business name
- DIASPORA RADIOLOGY, SC
- Practice address
- 2602 Mulberry LN
Northbrook, IL 60062-5937 - Phone
- (855) 694-3300
- NPI assigned
- Jan 9, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maria Corona
- Title
- Senior Director Operations
- Phone
- (855) 694-3300
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | |||
| Magnetic Resonance Imaging (MRI) Clinic/Center | 261QM1200X | Primary |
Addresses
Primary practice location
2602 Mulberry LN
Northbrook, IL 60062-5937
Mailing address
2602 Mulberry LN
Northbrook, IL 60062-5937
Phone (314) 238-5260
Other practice location 1
2106 Schofield Ave Ste 7
Weston, WI 54476-2412
Phone (855) 694-3300
Other practice location 2
8307 Murphy Dr
Middleton, WI 53562-2565
Phone (855) 694-3300
Other practice location 3
718 Florsheim Dr
Libertyville, IL 60048-3757
Phone (314) 238-5260
Other practice location 4
3004 Golf Rd Ste 101
Eau Claire, WI 54701-8794
Phone (855) 694-3300
Other practice location 5
350 S Greenleaf St Ste 401
Gurnee, IL 60031-5709
Phone (855) 694-3300
Other names 1
- Smart Scan Medical Imaging, SC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, WI
Enrollment records 2
National Provider Directory
National Provider Directory- Tax ID family
- Diaspora Radiology SC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Radiology Clinic/Center
- Middleton, WI
- NPI 1043937899
-
- Magnetic Resonance Imaging (MRI) Clinic/Center
- Eau Claire, WI
- NPI 1306583174
-
- Diagnostic Radiology Physician
- Weston, WI
- NPI 1861119612
Locations
718 Florsheim Dr
Libertyville, IL 60048
Phone (847) 362-4483
3111 W Rawson Ave
Ste 110
Franklin, WI 53132
8307 Murphy Dr
Middleton, WI 53562
Phone (608) 690-7210
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Peoria, IL
- NPI 1710936497
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546992000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720396800000",
"number": "1730652017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2602 MULBERRY LN",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600625937",
"telephone_number": "314-238-5260",
"fax_number": "314-821-1833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2602 MULBERRY LN",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600625937",
"telephone_number": "855-694-3300"
}
],
"practiceLocations": [
{
"address_1": "2106 Schofield Ave Ste 7",
"address_purpose": "LOCATION",
"city": "Weston",
"state": "WI",
"postal_code": "544762412",
"country_code": "US",
"telephone_number": "855-694-3300",
"fax_number": "715-514-1770",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8307 Murphy Dr",
"address_purpose": "LOCATION",
"city": "Middleton",
"state": "WI",
"postal_code": "535622565",
"country_code": "US",
"telephone_number": "855-694-3300",
"fax_number": "715-514-1770",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "718 Florsheim Dr",
"address_purpose": "LOCATION",
"city": "Libertyville",
"state": "IL",
"postal_code": "600483757",
"country_code": "US",
"telephone_number": "314-238-5260",
"fax_number": "314-821-1833",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3004 Golf Rd Ste 101",
"address_purpose": "LOCATION",
"city": "Eau Claire",
"state": "WI",
"postal_code": "547018794",
"country_code": "US",
"telephone_number": "855-694-3300",
"fax_number": "715-514-1770",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "350 S Greenleaf St Ste 401",
"address_purpose": "LOCATION",
"city": "Gurnee",
"state": "IL",
"postal_code": "600315709",
"country_code": "US",
"telephone_number": "855-694-3300",
"fax_number": "314-821-1833",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "DIASPORA RADIOLOGY, SC",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-09",
"last_updated": "2024-07-08",
"certification_date": "2024-07-08",
"status": "A",
"authorized_official_last_name": "CORONA",
"authorized_official_first_name": "MARIA",
"authorized_official_title_or_position": "SENIOR DIRECTOR OPERATIONS",
"authorized_official_telephone_number": "855-694-3300"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Smart Scan Medical Imaging, SC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.