NPIMap

Organization Active NPI

Penrad Imaging LLC

  • Radiology Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1770105900
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
PENRAD IMAGING LLC
Practice address
4925 N Nevada Ave
Colorado Springs, CO 80918-8600
Phone
(719) 593-1799
Fax
(719) 265-3794
NPI assigned
May 11, 2020
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Derek Scott Bergeson, MD
Title
Radiologist
Phone
(719) 593-1799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary

Addresses

Primary practice location

4925 N Nevada Ave
Colorado Springs, CO 80918-8600

Mailing address

1390 Kelly Johnson Blvd
Colorado Springs, CO 80920-3908
Phone (719) 593-1799

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420001609 CO Part B Supplier - Clinic/Group Practice 1850387598 Receives reassigned benefits from 26 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO; Monument, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Penrad Imaging LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1770105900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 KELLY JOHNSON BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809203908",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 N NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809188600",
            "telephone_number": "719-593-1799",
            "fax_number": "719-265-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENRAD IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "719-593-1799",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.