Advanced Diagnostic Radiology PC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

ADVANCED DIAGNOSTIC RADIOLOGY PC

Practice address

1301 15TH Ave W
Williston, ND 58801-3821

Phone

(701) 774-7401

NPI assigned

Jul 8, 2005

Last updated

Oct 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glenn P Moradian, MDNPI 1356349955

Title

President

Phone

(208) 557-0999

Specialties & licenses 1

Addresses

Other identifiers 6

Locations

Practitioners 3

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.

• Glenn P Moradian, MD

  • Diagnostic Radiology Physician
  • Williston, ND
  • NPI 1356349955
  NPD (past) Authorized official
• Madhusudhan P Reddy, MD

  • Diagnostic Radiology Physician
  • Williston, ND
  • NPI 1639389133
  NPD (past)
• Peter L Vance, MD

  • Diagnostic Radiology Physician
  • Idaho Falls, ID
  • NPI 1619056199
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224201600000",
    "number": "1922006519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2537",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588022537",
            "telephone_number": "866-338-6472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIAGNOSTIC RADIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2008-10-17",
        "status": "A",
        "authorized_official_last_name": "MORADIAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-557-0999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NUMBER",
            "identifier": "000010149528",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15040",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IDAHO",
            "identifier": "8M916",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC NUMBER FOR POCATELLO",
            "identifier": "POC - 8L501",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC NUMBER - IDAHO FALLS",
            "identifier": "IF - 8L493",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807083700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesslynn Adams
• Keisha Mae Adams, APRN, FNP-BC
• Ademola Elijah Adekunle
• Ruth Marie Adekunle
• Victor Ogooluwa Adenuga, M.D
• Letasha L Ahmed
• Abbey M Aide, M.S. CF-SLP
• Leslie Camille Aide, FNP
• Heather Akerley
• Francisca Chinonye Alberti

• Diagnostic Radiology Physician in Williston, ND
• Providers in Williston, ND by specialty
• Diagnostic Radiology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.