NPIMap

Organization Active NPI

All-Stat Portable Wi, LLC

  • Mobile Radiology Clinic/Center
  • Greenfield, WI
National Provider Identifier
1801420823
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
Legal business name
ALL-STAT PORTABLE WI, LLC
Practice address
4811 S 76TH St # 405
Greenfield, WI 53220-4364
Phone
(224) 337-0073
Fax
(224) 337-0074
NPI assigned
Feb 28, 2020
Last updated
Aug 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ALL-STAT PORTABLE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Authorized official

Name
Mr. Etai Sooliman
Title
Ceo
Phone
(224) 337-1199

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Radiology Clinic/Center 261QR0208X NU Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X NU

Addresses

Primary practice location

4811 S 76TH St # 405
Greenfield, WI 53220-4364

Mailing address

8235 Christiana Ave
Skokie, IL 60076-2910
Phone (224) 337-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210920001168 WI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4688078207 Practice locations: Greenfield, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
All-Stat Portable Wi LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4811 S 76th St
Ste 405
Greenfield, WI 53220
Phone (224) 337-0073

Practitioners & affiliated clinicians

Practitioners 5

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": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1801420823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8235 CHRISTIANA AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762910",
            "telephone_number": "224-337-1000",
            "fax_number": "224-337-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 S 76TH ST # 405",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532204364",
            "telephone_number": "224-337-0073",
            "fax_number": "224-337-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL-STAT PORTABLE WI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALL-STAT PORTABLE, LLC",
        "enumeration_date": "2020-02-28",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "SOOLIMAN",
        "authorized_official_first_name": "ETAI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "224-337-1199",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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.