Premier Medical Imaging LLC
Organization Active NPI Diagnostic Radiology Physician · Plymouth, IN
NPI 1821571399 · NPPES record last updated Apr 17, 2020
Key facts
- NPI
- 1821571399
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- PREMIER MEDICAL IMAGING LLC
- Practice address
- 2855 Miller Dr Ste 113
Plymouth, IN 46563-8091 - Phone
- (765) 228-4660
- NPI assigned
- Sep 11, 2018
- Organization subpart
- No
Authorized official
- Name
- Jackie-Dee Gardner Bartrom
- Title
- President
- Phone
- (765) 228-4660
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 17
-
Steven L Hossler, M.D.
-
Orlando Landrum, MD
-
Adel Abdalla, M.D.
-
Richard Lance Dejournett, M.D.
-
Mark L Harshany, MD
-
Bryan Lee Kaufman, M.D.
-
Ron Mark, M.D.
-
Philip B. McDonald, M.D.
-
Justin Hung Pham, M.D.
-
Ranjiv Kumar Saini, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190121000051 | IN | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 7113264714 | Practice locations: Plymouth, IN |
National Provider Directory
- Tax ID family
- Premier Medical Imaging LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
2855 Miller Dr Ste 113
Plymouth, IN 46563-8091
Mailing address
PO Box 338
La Fontaine, IN 46940-0338
Phone (765) 228-4660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300021965 | Medicaid | IN |
Other providers in Plymouth, IN
- Plymouth Towne Care Pharmacy Inc
- Margaret Jean Ponto
- Prairie View Therapeutic Group Homes, Inc.
- Bailey Prater
- Premier Medical Imaging LLC
- Tori D. Prendergast
- Erin M Pretzer
- Proactive Mso, LLC
- Abdul Sami Qazi
- Quality Optical Inc
All providers in Plymouth, IN · Diagnostic Radiology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.