Active NPI
Alex William Widmer, RT R VI
- Radiology Practitioner Assistant
- Rome, GA
National Provider Identifier
1801510680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- 23RRAGA0213
- Practice address
- 901 N Broad St NE
Rome, GA 30161-5201 - Phone
- (706) 291-2661
- NPI assigned
- Sep 27, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular-Interventional Technology Radiologic Technologist | 2471V0106X | 581533 | ND | |
| Radiology Practitioner Assistant | 243U00000X | 23RRAGA0213 | GA | Primary |
Addresses
Primary practice location
901 N Broad St NE
Rome, GA 30161-5201
Mailing address
17 Dublin Way NW
Adairsville, GA 30103-3505
Phone (701) 306-4725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23RRAGA0213 | GA | MD | Radiology Practitioner Assistant |
| 581533 | ND | MD | Vascular-Interventional Technology Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1801510680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 DUBLIN WAY NW",
"city": "ADAIRSVILLE",
"state": "GA",
"postal_code": "301033505",
"telephone_number": "701-306-4725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 N BROAD ST NE",
"city": "ROME",
"state": "GA",
"postal_code": "301615201",
"telephone_number": "706-291-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDMER",
"first_name": "ALEX",
"middle_name": "WILLIAM",
"credential": "RT R VI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-27",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "2471V0106X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Vascular-Interventional Technology",
"state": "ND",
"license": "581533",
"primary": false
},
{
"code": "243U00000X",
"taxonomy_group": "",
"desc": "Radiology Practitioner Assistant",
"state": "GA",
"license": "23RRAGA0213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.