Active NPI
Steward Pet Imaging LLC
- Mobile Radiology Clinic/Center
- Northampton, MA
National Provider Identifier
1841450004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mobile Radiology Clinic/Center
- License
- 4NNJ
- Legal business name
- STEWARD PET IMAGING LLC
- Practice address
- 30 Locust Street
Cooley Dickinson Hospital
Northampton, MA 01061 - Phone
- (877) 877-8455
- Fax
- (866) 927-0079
- NPI assigned
- Jun 11, 2008
- Organization subpart
- Yes
- Parent organization
- STEWARD PET IMAGING LLC
NPPES NPI Registry
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
- Phone
- (617) 789-5047
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mobile Radiology Clinic/Center | 261QR0208X | 4NNJ | MA | Primary |
Addresses
Primary practice location
30 Locust Street
Cooley Dickinson Hospital
Northampton, MA 01061
Mailing address
800 Washington St
Norwood, MA 02062-3487
Phone (877) 877-8455
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110073236I | Medicaid | MA |
Other names 1
- Steward PET Imaging LLC at Cooley Dickinson Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
-
- Mobile Radiology Clinic/Center
- Holyoke, MA
- NPI 1356599542
O20041206000621
-
- Mobile Radiology Clinic/Center
- Fall River, MA
- NPI 1447408638
O20041206000621
-
- Mobile Radiology Clinic/Center
- Dorchester Center, MA
- NPI 1578710653
O20041206000621
-
- Mobile Radiology Clinic/Center
- Brockton, MA
- NPI 1679720379
O20041206000621
National Provider Directory
National Provider Directory- Part of
- Steward Pet Imaging LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1323820800000",
"number": "1841450004",
"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": "30 LOCUST STREET",
"address_2": "COOLEY DICKINSON HOSPITAL",
"city": "NORTHAMPTON",
"state": "MA",
"postal_code": "01061",
"telephone_number": "877-877-8455",
"fax_number": "866-927-0079"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STEWARD PET IMAGING LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "STEWARD PET IMAGING LLC",
"enumeration_date": "2008-06-11",
"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",
"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": "110073236I",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Steward PET Imaging LLC at Cooley Dickinson Hospital",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Northampton, 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.