NPIMap

Organization Active NPI

Steward Pet Imaging LLC

Doing business as Steward PET Imaging LLC at Hawthorn Medical Associates

  • Mobile Radiology Clinic/Center
  • Dartmouth, MA
National Provider Identifier
1821310368
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
License
4NNJ Issued in MA
Legal business name
STEWARD PET IMAGING LLC
Doing business as
Steward PET Imaging LLC at Hawthorn Medical Associates
Practice address
535 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone
(877) 877-8455
Fax
(866) 927-0079
NPI assigned
Feb 25, 2010
Last updated
Dec 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Mr. Robert E. Guyon Jr.
Title
Coo - Managing Member
Phone
(617) 789-5047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Radiology Clinic/Center 261QR0208X 4NNJ MA Primary

Addresses

Primary practice location

535 Faunce Corner Rd
Dartmouth, MA 02747-1242

Mailing address

800 Washington St
Norwood, MA 02062-3487
Phone (877) 877-8455

Other identifiers 2

IdentifierTypeStateIssuer
110073236MMedicaidMA
4NNJOtherMADEPT PUBLIC HEALTH STATE LICENSE

Other names 1

  • Steward PET Imaging LLC at Hawthorn Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041206000621 MA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7214831056 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norwood, MA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1821310368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST",
            "city": "NORWOOD",
            "state": "MA",
            "postal_code": "020623487",
            "telephone_number": "877-877-8455",
            "fax_number": "866-927-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 FAUNCE CORNER RD",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "027471242",
            "telephone_number": "877-877-8455",
            "fax_number": "866-927-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWARD PET IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "GUYON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "COO - MANAGING MEMBER",
        "authorized_official_telephone_number": "617-789-5047",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "MA",
            "license": "4NNJ",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110073236M",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT PUBLIC HEALTH STATE LICENSE",
            "identifier": "4NNJ",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steward PET Imaging LLC at Hawthorn Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dartmouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; 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.