NPIMap

Organization Active NPI

M DS Cyber Clinic PA

Doing business as Northwest Diagnostic Clinic

  • Clinic/Center
  • Cedar Park, TX
National Provider Identifier
1780612390
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
H6779 Issued in TX
Legal business name
M DS CYBER CLINIC PA
Doing business as
Northwest Diagnostic Clinic
Practice address
500 W Whitestone Blvd
Suite 100
Cedar Park, TX 78613-2245
Phone
(512) 250-3900
Fax
(512) 249-6232
NPI assigned
Jun 30, 2006
Last updated
Jan 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Authorized official

Name
Michael Bruce Bogdanovich, MDNPI 1386609048
Title
President
Phone
(512) 250-3900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X H6779 TX Primary

Addresses

Primary practice location

500 W Whitestone Blvd
Suite 100
Cedar Park, TX 78613-2245

Mailing address

500 W Whitestone Blvd
Suite 100
Cedar Park, TX 78613-2245
Phone (512) 250-3900

Other identifiers 1

IdentifierTypeStateIssuer
00769NOtherTXMEDICARE PTAN

Other names 1

  • Northwest Diagnostic Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357257600000",
    "number": "1780612390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W WHITESTONE BLVD",
            "address_2": "SUITE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132245",
            "telephone_number": "512-250-3900",
            "fax_number": "512-249-6232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W WHITESTONE BLVD",
            "address_2": "SUITE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132245",
            "telephone_number": "512-250-3900",
            "fax_number": "512-249-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M DS CYBER CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2013-01-04",
        "status": "A",
        "authorized_official_last_name": "BOGDANOVICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-250-3900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "H6779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00769N",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Diagnostic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; 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.