NPIMap

Organization Active NPI

Lourdes Imaging Associates PA

  • Diagnostic Radiology Physician
  • Camden, NJ
National Provider Identifier
1952330599
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LOURDES IMAGING ASSOCIATES PA
Practice address
1600 Haddon Avenue
Camden, NJ 08103-3117
Phone
(330) 412-3057
NPI assigned
Jul 3, 2006
Last updated
Aug 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Authorized official

Name
Joseph Benjamin Broudy, MDNPI 1689706434
Title
President
Phone
(330) 412-3057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

1600 Haddon Avenue
Camden, NJ 08103-3117

Mailing address

PO Box 31037
Newark, NJ 07101
Phone (614) 689-1691

Other identifiers 1

IdentifierTypeStateIssuer
7224702MedicaidNJ

Other names 1

  • PA Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA, IL, CA, MI5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20050107000262 NJ Part B Supplier - Clinic/Group Practice 2264480235 Receives reassigned benefits from 15 practitioners
Practice locations: Camden, NJ; Cherry Hill, NJ; Moorestown, NJ; Willingboro, NJ; Wrightstown, NJ
O20200107000069 PA Part B Supplier - Clinic/Group Practice 2264480235 Receives reassigned benefits from 1 practitioner
Practice locations: Plymouth Meeting, PA
O20200115001737 IL Part B Supplier - Clinic/Group Practice 2264480235 Receives reassigned benefits from 1 practitioner
Practice locations: Naperville, IL
O20200121000495 CA Part B Supplier - Clinic/Group Practice 2264480235 Practice locations: Clovis, CA
O20200715002565 MI Part B Supplier - Clinic/Group Practice 2264480235 Receives reassigned benefits from 1 practitioner
Practice locations: Novi, MI

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1 Brace Rd
Ste E
Cherry Hill, NJ 08034
Phone (856) 874-0791

231 Van Sciver Pkwy
Willingboro, NJ 08046
Phone (609) 871-7500

25 Wrightstown Cookstown Rd
Wrightstown, NJ 08562
Phone (609) 444-5690

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1952330599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31037",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07101",
            "telephone_number": "614-689-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 HADDON AVENUE",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081033117",
            "telephone_number": "330-412-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOURDES IMAGING ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "BROUDY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-412-3057",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7224702",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PA",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Camden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.