NPIMap

Organization Active NPI

Radiology Muskegon PC

  • Diagnostic Radiology Physician
  • Muskegon, MI
National Provider Identifier
1841208071
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY MUSKEGON PC
Practice address
1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone
(231) 672-3955
Fax
(231) 672-3806
NPI assigned
Aug 3, 2006
Last updated
Aug 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Mr. Stephen C Vaughan, CPA
Title
Administrator
Phone
(231) 722-6005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1500 E Sherman Blvd
Muskegon, MI 49444-1849

Mailing address

605 W Western Ave
Muskegon, MI 49440-1080
Phone (231) 722-6005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WA, TX, AZ, CA, DC, NC, MA8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20040109000458 MI Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 27 practitioners
Practice locations: Muskegon, MI; Shelby, MI; Grand Haven, MI; Franklin, MI; Farmington Hills, MI
O20201103002503 WA Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 4 practitioners
Practice locations: Anacortes, WA; Clyde Hill, WA; Kirkland, WA; Lake Tapps, WA
O20201118001194 TX Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 1 practitioner
Practice locations: Sugar Land, TX
O20201119001710 AZ Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 3 practitioners
Practice locations: Scottsdale, AZ; Rio Verde, AZ
O20201120001133 CA Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 2 practitioners
Practice locations: San Francisco, CA; San Juan Capistrano, CA
O20201202000267 DC Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 2 practitioners
Practice locations: Alexandria, VA; Arlington, VA
O20201211002581 NC Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 1 practitioner
Practice locations: Asheville, NC
O20210121000390 MA Part B Supplier - Clinic/Group Practice 1355241191 Receives reassigned benefits from 1 practitioner
Practice locations: Weston, MA

National Provider Directory

National Provider Directory

Locations

900 3rd St
Ste 104
Muskegon, MI 49440
Phone (231) 722-6005

3535 Park St
Ste 105
Norton Shores, MI 49444
Phone (231) 739-7191

Practitioners & affiliated clinicians

Practitioners 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1841208071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 W WESTERN AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494401080",
            "telephone_number": "231-722-6005",
            "fax_number": "231-726-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441849",
            "telephone_number": "231-672-3955",
            "fax_number": "231-672-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY MUSKEGON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-722-6005",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.