NPIMap

Organization Active NPI

Radiologic Imaging Consultants, LLP

  • Diagnostic Radiology Physician
  • Saint Charles, MO
National Provider Identifier
1871689505
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGIC IMAGING CONSULTANTS, LLP
Practice address
300 First Capitol Drive
St Charles, MO 63301
Phone
(636) 947-5444
NPI assigned
Oct 4, 2006
Last updated
Feb 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Authorized official

Name
Jonathan Root, M.D.NPI 1033139696
Title
Partner
Phone
(636) 947-4480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU

Addresses

Primary practice location

300 First Capitol Drive
St Charles, MO 63301

Mailing address

220 Compass Point Dr
St Charles, MO 63301
Phone (636) 947-4480

Other practice location 1

100 Medical Plz
Lake St Louis, MO 63367-1366
Phone (636) 625-5303

Other identifiers 9

IdentifierTypeStateIssuer
266417OtherMOFEDERAL BLACK LUNG
438386OtherMOHEALTHLINK GROUP NUMBER
4355OtherMOGROUP HEALTH PLAN
O16294OtherMOFMH EXCLUSIVE CHOICE
21317X21317OtherMOHEALTHCARE USA GROUP NUMB
06022955OtherILBLUE CROSS & BLUE SHIELD
117184OtherMOBLUE CROSS & BLUE SHIELD
503988503MedicaidMO
370477200OtherMOUS DEPARTMENT OF LABOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000834 MO Part B Supplier - Clinic/Group Practice 4587652748 Receives reassigned benefits from 21 practitioners
Practice locations: Saint Charles, MO; Wentzville, MO; Troy, MO; Ofallon, MO; Lake Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

164 Professional Pkwy
#164
Troy, MO 63379
Phone (636) 528-0392

164 Professional Pkwy
Ste 164
Troy, MO 63379
Phone (636) 528-0392

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1871689505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 COMPASS POINT DR",
            "city": "ST CHARLES",
            "state": "MO",
            "postal_code": "63301",
            "telephone_number": "636-947-4480",
            "fax_number": "636-947-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FIRST CAPITOL DRIVE",
            "city": "ST CHARLES",
            "state": "MO",
            "postal_code": "63301",
            "telephone_number": "636-947-5444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Medical Plz",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633671366",
            "country_code": "US",
            "telephone_number": "636-625-5303",
            "fax_number": "636-947-9860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RADIOLOGIC IMAGING CONSULTANTS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "ROOT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "636-947-4480",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "266417",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK GROUP NUMBER",
            "identifier": "438386",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "4355",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FMH EXCLUSIVE CHOICE",
            "identifier": "O16294",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA GROUP NUMB",
            "identifier": "21317X21317",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "06022955",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "117184",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503988503",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "370477200",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.