Active NPI
Prime Radiology
- Diagnostic Radiology Physician
- Port St. Lucie, FL
National Provider Identifier
1942559869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- OS 11058
- Legal business name
- PRIME RADIOLOGY
- Practice address
- 1700 SE Hillmore Drive
Port St. Lucie, FL 34952 - Phone
- (772) 335-9600
- NPI assigned
- Sep 6, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jeffrey S Bong, D.O.
- Title
- President
- Phone
- (630) 430-5085
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | OS 11058 | FL | Primary |
Addresses
Primary practice location
1700 SE Hillmore Drive
Port St. Lucie, FL 34952
Mailing address
3000 N. Ocean Drive Apt#34B
West Palm Beach, FL 33404
Phone (630) 430-5085
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016496019 | Other | KS | MEDICARE PTAN |
| NC0317A334 | Other | NC | MEDICARE PTAN |
| 8L14039 | Other | TX | MEDICARE PTAN |
| 8L24510 | Other | TX | MEDICARE PTAN |
| 114630005 | Other | MO | MEDICARE PTAN |
| 8L24508 | Other | TX | MEDICARE PTAN |
| NC0317A427 | Other | NC | MEDICARE PTAN |
| 229515YFP0 | Other | MD | MEDICARE PTAN |
| TXB137170 | Other | TX | MEDICARE PTAN |
| 1881800621 | Other | INDIVIDUAL NPI | |
| 2021303296 | Other | GA | MEDICARE PTAN |
| MC03179974 | Other | NC | MEDICARE PTAN |
| 8L24509 | Other | TX | MEDICARE PTAN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346889600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1346889600000",
"number": "1942559869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 N. OCEAN DRIVE APT#34B",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33404",
"telephone_number": "630-430-5085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 SE HILLMORE DRIVE",
"city": "PORT ST. LUCIE",
"state": "FL",
"postal_code": "34952",
"telephone_number": "772-335-9600"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIME RADIOLOGY",
"organizational_subpart": "NO",
"enumeration_date": "2012-09-06",
"last_updated": "2012-09-06",
"status": "A",
"authorized_official_last_name": "BONG",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "630-430-5085",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "OS 11058",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "016496019",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "NC0317A334",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "8L14039",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "8L24510",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "114630005",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "8L24508",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "NC0317A427",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "229515YFP0",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "TXB137170",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL NPI",
"identifier": "1881800621",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "2021303296",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "MC03179974",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "8L24509",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port St. Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.