Portable Radiology Services LLC

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

PORTABLE RADIOLOGY SERVICES LLC

Practice address

8948 Kennemer Cir NW
North Canton, OH 44720-8237

Phone

(330) 433-0465

Fax

(330) 433-0466

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Nicole Lynn Olear, R.T.

Title

Owner

Phone

(330) 433-0465

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Portable X-ray supplier certification: CCN 36X0009873

Legal name

PORTABLE RADIOLOGY SERVICES, LLC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jul 7, 2005

Last certification

Jul 17, 2017

Ownership / control type

Other Than Private

Facility address

8948 Kennemer Circle, NW
North Canton, OH 44720

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902941412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8948 KENNEMER CIR NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447208237",
            "telephone_number": "330-433-0465",
            "fax_number": "330-433-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8948 KENNEMER CIR NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447208237",
            "telephone_number": "330-433-0465",
            "fax_number": "330-433-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE RADIOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLEAR",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-433-0465",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.T."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00235222",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "16-02180",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMETOWN",
            "identifier": "A9999",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2599880",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000376207",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Emily Poliuk, MA
• Ashli Pollock
• Jacqueline E Pompignano, L/PTA
• Michael D Poorman, COTA/L
• Robert Popernack Jr., LPTA
• Portage Family Practice Clinic, Inc.
• Nicholas Potenzini
• Christopher John Potter, ATC
• Katelyn E Potter
• Brooke Potts, COTA

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in North Canton, OH
• Providers in North Canton, OH by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.