NPIMap

Organization Active NPI

Breast Diagnostic Center, LLC

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
National Provider Identifier
1790748499
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BREAST DIAGNOSTIC CENTER, LLC
Practice address
3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone
(260) 471-9466
NPI assigned
Apr 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Dr. Adam M Gregory, M.D.NPI 1194926493
Title
President
Phone
(260) 471-9466

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

3707 New Vision Dr
Fort Wayne, IN 46845-1702

Mailing address

3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone (260) 471-9466

Other practice location 1

1818 Carew St
Fort Wayne, IN 46805-4788
Phone (260) 483-1847

Other identifiers 1

IdentifierTypeStateIssuer
100080340AMedicaidIN

Other names 1

  • BREAST DIAGNOSTIC SCREENING CENTER, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050506000308 IN Part B Supplier - Clinic/Group Practice 9335189513 Receives reassigned benefits from 29 practitioners
Practice locations: Fort Wayne, IN; Indianapolis, IN; Grabill, IN; Auburn, IN

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1818 Carew St
Ste 30
Fort Wayne, IN 46805
Phone (260) 425-5900

1818 Carew St
Ste 40
Fort Wayne, IN 46805
Phone (219) 483-1847

2110 Carew St
Fort Wayne, IN 46805
Phone (219) 432-6710

7230 Engle Rd
Ste 110
Fort Wayne, IN 46804
Phone (219) 484-0850

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1790748499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451702",
            "telephone_number": "260-471-9466",
            "fax_number": "260-484-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451702",
            "telephone_number": "260-471-9466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 Carew St",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468054788",
            "country_code": "US",
            "telephone_number": "260-483-1847",
            "fax_number": "260-484-5919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BREAST DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-471-9466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080340A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BREAST DIAGNOSTIC SCREENING CENTER, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BREAST DIAGNOSTIC SCREENING CENTER, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

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

Verify at the official NPI Registry.