NPIMap

Organization Active NPI

Imaging Diagnostic Center Limited

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
National Provider Identifier
1871564336
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
IMAGING DIAGNOSTIC CENTER LIMITED
Practice address
7900 W Jefferson Blvd Ste 101
Fort Wayne, IN 46804-4128
Phone
(260) 432-1568
Fax
(260) 432-4969
NPI assigned
Jan 31, 2006
Last updated
Jul 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Mr. Mark William Schaefer
Title
Executive Director
Phone
(260) 435-7898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

7900 W Jefferson Blvd Ste 101
Fort Wayne, IN 46804-4128

Mailing address

6119 W Jefferson Blvd
Imaging Diagnostic Center
Fort Wayne, IN 46804-3072
Phone (260) 432-1568

Other identifiers 4

IdentifierTypeStateIssuer
0753475MedicaidOH
CA8912OtherINMEDICARE RAILROAD
0787251MedicaidOH
100081420MedicaidIN

National Provider Directory

National Provider Directory

Locations

7900 W Jefferson Blvd
Ste 101
Fort Wayne, IN 46804

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1871564336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6119 W JEFFERSON BLVD",
            "address_2": "IMAGING DIAGNOSTIC CENTER",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468043072",
            "telephone_number": "260-432-1568",
            "fax_number": "260-432-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD STE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-432-1568",
            "fax_number": "260-432-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGING DIAGNOSTIC CENTER LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "260-435-7898",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0753475",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CA8912",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0787251",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100081420",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.