Jefferson University Radiology Associates, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC

Doing business as

Jefferson Outpatient Imaging

Practice address

1 W Germantown Pike
East Norriton, PA 19401-1513

Phone

(615) 277-3202

Fax

(610) 277-9640

NPI assigned

Sep 21, 2010

Last updated

Oct 21, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLCAs reported in NPPES

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

Authorized official

Name

Amy Stout

Title

President/Ceo

Phone

(615) 261-2306

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jefferson Outpatient Imaging Doing business as

Part of

Jefferson Univ Radio Assoc

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Jefferson University Physicians

  • General Practice Physician
  • Philadelphia, PA
  • NPI 1326093675

  Member Of

  NPD member
• Thomas Jefferson University Hospitals Inc

  • Psychiatric Hospital Unit
  • Philadelphia, PA
  • NPI 1124038799

  Member Of

  NPD member

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

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1902114168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRESCENT CENTRE DR STE 400",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677270",
            "telephone_number": "615-261-2306",
            "fax_number": "855-588-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W GERMANTOWN PIKE",
            "city": "EAST NORRITON",
            "state": "PA",
            "postal_code": "194011513",
            "telephone_number": "615-277-3202",
            "fax_number": "610-277-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON UNIVERSITY RADIOLOGY ASSOCIATES, LLC",
        "enumeration_date": "2010-09-21",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "615-261-2306"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDTF (MOBILE PET/CT)",
            "identifier": "205517",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDTF (MOBILE PET/CT)",
            "identifier": "255184",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Outpatient Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanya Ibrahim
• Dexter Doromal Jacob, M.D.
• Atousa Jahanshahi
• Nora Jamil
• Jefferson University Radiology Associates, LLC (Jefferson Outpatient Imaging)
• Jeffersonville Family and Geriatric Medicine, LLC
• Polly Elizabeth Jenkins
• Abbi Johns, MD
• Mercy Johnson, RPH
• Mitchell E. Kaltz, D.M.D.

• Diagnostic Radiology Physician in East Norriton, PA
• Providers in East Norriton, PA by specialty
• Diagnostic Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.