Pro Radiology, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PRO RADIOLOGY, LLC

Practice address

3921 Johns Creek CT
Suite B
Johns Creek, GA 30024

Phone

(770) 217-7414

Fax

(770) 217-7142

NPI assigned

Apr 4, 2017

Last updated

Jul 19, 2024By 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

Katrina Roelle

Title

Director of Credentialing

Phone

(614) 689-1691

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, FL, NY, MT, WA, PA, OK, CO, CA, VA, SC, KY, WI, TX, NC, AL, MI, NM, NJ19 enrollments

Enrollment records 19

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Pro Radiology, LLC

  • Radiology Clinic/Center
  • Atlanta, GA
  • NPI 1164966461

  1052696432

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pro Radiology, LLC

  • Radiology Clinic/Center
  • Atlanta, GA
  • NPI 1164966461

  O20170327002470

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pro Radiology LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pro Radiology, LLC

  • Radiology Clinic/Center
  • Atlanta, GA
  • NPI 1164966461
  NPD tax ID

Locations

Practitioners 131

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.

• David A Costantino, MD

  • Diagnostic Radiology Physician
  • Albany, GA
  • NPI 1518167725

  CO

  Medicare reassignment Care Compare group NPD
• Nicholas Mark Gutierrez, M.D.

  • Diagnostic Radiology Physician
  • Albany, GA
  • NPI 1457643033

  FL

  Medicare reassignment Care Compare group NPD
• Michael Im, M.D.

  • Diagnostic Radiology Physician
  • Albany, GA
  • NPI 1710154794

  CA

  Medicare reassignment Care Compare group NPD
• Jack Russelle Lake, D.O.

  • Diagnostic Radiology Physician
  • Albany, GA
  • NPI 1932248101

  OK

  Medicare reassignment Care Compare group NPD
• Steven R. Ullrick, M.D.

  • Diagnostic Radiology Physician
  • Albany, GA
  • NPI 1871536482

  WI

  Medicare reassignment Care Compare group NPD
• Benjamin A Aronovitz, M.D.

  • Diagnostic Radiology Physician
  • Arlington, TX
  • NPI 1679532253

  CO

  Medicare reassignment Care Compare group NPD
• Paraag Ravi Bhatt, M.D.

  • Diagnostic Radiology Physician
  • Denver, CO
  • NPI 1134549462
  Medicare reassignment Care Compare group NPD
• Garen Boghosian, M.D.

  • Neuroradiology Physician
  • Arlington, TX
  • NPI 1043421282

  PA

  Medicare reassignment Care Compare group NPD
• Garth Brandal

  • Diagnostic Radiology Physician
  • Arlington, TX
  • NPI 1700204989

  CA

  Medicare reassignment Care Compare group NPD
• Louis Brisson, MD

  • Diagnostic Radiology Physician
  • Rochester, MI
  • NPI 1912966755
  Medicare reassignment Care Compare group NPD
• Gregory Horton Broering, M.D.

  • Diagnostic Radiology Physician
  • Lakewood, CO
  • NPI 1578821500
  Medicare reassignment Care Compare group NPD
• Sean O. Bryant, M.D.

  • Diagnostic Radiology Physician
  • Lakewood, CO
  • NPI 1700897477
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1942733308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746534",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 JOHNS CREEK CT",
            "address_2": "SUITE B",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "770-217-7414",
            "fax_number": "770-217-7142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO RADIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-04",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "ROELLE",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "614-689-1691"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Specialty Pharmacy LLC
• Prestige Pharmacy Johns Creek, LLC (Prestige Pharmacy)
• Krista Price
• Pritchett Eye Care LLC
• Mridula Priyadarshini, MA (COUNSELING), APC
• Lyndsey Blake Pulliam, CNM
• Puresoul Tradings LLC
• Venkata Shiva Puttagunta
• Pyramid Family Behavioral Healthcare LLC (Pyramid Healthcare Assessment Center)
• Pyramid Family Behavioral Healthcare LLC

• Radiology Clinic/Center in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Radiology Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.