Active NPI
Donald Bouldin, RT
- Mobile Radiology Clinic/Center
- Lewisville, TX
National Provider Identifier
1760188908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mobile Radiology Clinic/Center
- License
- GMR02006320
- Practice address
- 1338 Juniper LN
Lewisville, TX 75077-2838 - Phone
- (214) 498-9558
- NPI assigned
- Jan 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mobile Radiology Clinic/Center | 261QR0208X | GMR02006320 | TX | Primary |
Addresses
Primary practice location
1338 Juniper LN
Lewisville, TX 75077-2838
Mailing address
1338 Juniper LN
Lewisville, TX 75077-2838
Phone (214) 498-9558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GMR02006320 | TX | MD | Mobile Radiology Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ambulant Imaging LLC | Radiology, Mobile | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1760188908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1338 JUNIPER LN",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750772838",
"telephone_number": "214-498-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1338 JUNIPER LN",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750772838",
"telephone_number": "214-498-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULDIN",
"first_name": "DONALD",
"credential": "RT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-31",
"last_updated": "2023-02-28",
"certification_date": "2023-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "261QR0208X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology, Mobile",
"state": "TX",
"license": "GMR02006320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.