NPIMap

Organization Active NPI

Proscan Imaging of Indianapolis, LLC

Doing business as ProScan Imaging of Fishers

  • Diagnostic Radiology Physician
  • Fishers, IN
National Provider Identifier
1811057938
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PROSCAN IMAGING OF INDIANAPOLIS, LLC
Doing business as
ProScan Imaging of Fishers
Practice address
9780 Lantern Rd
Suite 250
Fishers, IN 46037-4092
Phone
(317) 579-7700
Fax
(317) 579-8800
NPI assigned
Dec 11, 2006
Last updated
Jan 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Mike D. O'Brien
Title
Coo
Phone
51392813400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

9780 Lantern Rd
Suite 250
Fishers, IN 46037-4092

Mailing address

9780 Lantern Rd
Suite 250
Fishers, IN 46037-4092
Phone (317) 579-7700

Other identifiers 1

IdentifierTypeStateIssuer
000000477513OtherANTHEM PIN

Other names 1

  • ProScan Imaging of Fishers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070129000459 IN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 5991706301 Practice locations: Fishers, IN

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Proscan Imaging of Indianapolis LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

9780 Lantern Rd
Ste 250
Fishers, IN 46037
Phone (317) 579-7700

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1811057938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9780 LANTERN RD",
            "address_2": "SUITE 250",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460374092",
            "telephone_number": "317-579-7700",
            "fax_number": "317-579-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9780 LANTERN RD",
            "address_2": "SUITE 250",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460374092",
            "telephone_number": "317-579-7700",
            "fax_number": "317-579-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSCAN IMAGING OF INDIANAPOLIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "51392813400"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000477513",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProScan Imaging of Fishers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fishers, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.