NPIMap

Organization Active NPI

Southeast Radiology LTD

  • Diagnostic Radiology Physician
  • Chester, PA
National Provider Identifier
1790779684
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD015422E Issued in PA
Legal business name
SOUTHEAST RADIOLOGY LTD
Practice address
1 Medical Center Blvd
Chester, PA 19013-3902
Phone
(610) 447-2517
Fax
(610) 956-0069
NPI assigned
Sep 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Authorized official

Name
John Hiehle, MDNPI 1013901743
Title
President
Phone
(610) 447-2500

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X MD015422E PA
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X MD015422E PA Primary

Addresses

Primary practice location

1 Medical Center Blvd
Chester, PA 19013-3902

Mailing address

PO Box 3247
Evansville, IN 47731-3247
Phone (800) 467-2392

Other identifiers 1

IdentifierTypeStateIssuer
0009311400027MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000107 PA Part B Supplier - Clinic/Group Practice 9133025232 Receives reassigned benefits from 43 practitioners
Practice locations: Springfield, PA; Ridley Park, PA; Media, PA; Drexel Hill, PA; Glen Mills, PA; Broomall, PA; Chester, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 86

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

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1790779684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3247",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477313247",
            "telephone_number": "800-467-2392",
            "fax_number": "812-471-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133902",
            "telephone_number": "610-447-2517",
            "fax_number": "610-956-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST RADIOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "HIEHLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-447-2500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "PA",
            "license": "MD015422E",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD015422E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009311400027",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.