Diaspora Radiology, SC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

DIASPORA RADIOLOGY, SC

Doing business as

Smart Scan Medical Imaging, LLC

Practice address

111 Sand Lake Rd
Onalaska, WI 54650-2760

Phone

(847) 878-9109

NPI assigned

Oct 24, 2022

Last updated

Oct 24, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

DIASPORA RADIOLOGY, SCAs reported in NPPES

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

(847) 878-9109

Specialties & licenses 1

Addresses

Other names 1

• Smart Scan Medical Imaging, LLC Doing business as

Part of

Diaspora Radiology SC

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666569600000",
    "number": "1790402543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 PINE DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600512620",
            "telephone_number": "847-878-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SAND LAKE RD",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546502760",
            "telephone_number": "847-878-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIASPORA RADIOLOGY, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIASPORA RADIOLOGY, SC",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-23",
        "status": "A",
        "authorized_official_last_name": "CORONA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, OPERATIONS",
        "authorized_official_telephone_number": "847-878-9109"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smart Scan Medical Imaging, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diagnostic Radiology Physician in Onalaska, WI
• Providers in Onalaska, WI by specialty
• Diagnostic Radiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.