NPIMap

Organization Active NPI

Medical Diagnostic Services Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Waterford, MI
National Provider Identifier
1861648917
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
Legal business name
MEDICAL DIAGNOSTIC SERVICES INC
Practice address
4479 Pontiac Lake Rd
Suite 1D
Waterford, MI 48328-2059
Phone
(248) 499-7618
Fax
(248) 499-7644
NPI assigned
Aug 8, 2008
Organization subpart
Yes
Parent organization
MEDICAL DIAGNOSTIC SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Authorized official

Name
Mr. Shams Siddiqui
Title
President
Phone
(847) 626-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X Primary

Addresses

Primary practice location

4479 Pontiac Lake Rd
Suite 1D
Waterford, MI 48328-2059

Mailing address

3701 Jarvis Ave
Skokie, IL 60076-4019
Phone (847) 626-0800

Other identifiers 3

IdentifierTypeStateIssuer
P00658473OtherMIRAILROAD MEDICARE PIN
0H01066OtherMIBLUE CROSS BLUE SHIELD PIN
0F38158OtherMIBCBS PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071025000145 MI Part B Supplier - Portable X-Ray Supplier 5890893275 Practice locations: Waterford, MI

Portable X-ray supplier certification: CCN 23X0009838

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MEDICAL DIAGNOSTIC SERVICES
Certification status
Active
Provider type (POS)
Portable X-ray supplier
Participating since
Sep 25, 2008
Last certification
Aug 26, 2021
Ownership / control type
Corporation
Facility address
4479 Pontiac Lake Road, Suite 4479
Waterford, MI 48328

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Medical Diag Services Inc6 organizations share this tax ID, including this one
Part of
Medical Diag Services Inc

Other organizations with this tax ID 5

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

Locations

213 W Michigan Ave
Paw Paw, MI 49079
Phone (269) 657-9905

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1861648917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 JARVIS AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600764019",
            "telephone_number": "847-626-0800",
            "fax_number": "847-626-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4479 PONTIAC LAKE RD",
            "address_2": "SUITE 1D",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483282059",
            "telephone_number": "248-499-7618",
            "fax_number": "248-499-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL DIAGNOSTIC SERVICES INC",
        "enumeration_date": "2008-08-08",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUI",
        "authorized_official_first_name": "SHAMS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-626-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P00658473",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PIN",
            "identifier": "0H01066",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "0F38158",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.