Active NPI
Pueblo Medical Imaging, LLC
- Diagnostic Radiology Physician
- Las Vegas, NV
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- PUEBLO MEDICAL IMAGING, LLC
- Practice address
- 5495 S Rainbow Blvd Ste 101
Las Vegas, NV 89118-1872 - Phone
- (702) 228-0031
- NPI assigned
- May 16, 2006
- Last updated
- Jun 28, 2023
- 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
- Micah K Nielsen, M.D.
- Title
- President
- Phone
- (702) 477-0772
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | NU | ||
| Diagnostic Radiology Physician | 2085R0202X | NU | Primary |
Addresses
Primary practice location
5495 S Rainbow Blvd Ste 101
Las Vegas, NV 89118-1872
Mailing address
PO Box 30077
Dept 306
Salt Lake City, UT 84130-0077
Phone (702) 228-0031
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NV1651 | Other | NV | BCBS OF NV |
| 100500056 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV, TX, FL, OK, VA, NY, CA, TN, OH, DC, NC, DE
Enrollment records 12
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Radiology Associates of Nevada
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1487606026
Member Of
Locations
Dept LA 21605
Pasadena, CA 91185
2555 Montessouri St
Ste C
Las Vegas, NV 89117
8551 W Lake Mead Blvd
Ste 150
Las Vegas, NV 89128
Phone (702) 683-5516
9499 W Charleston Blvd
Ste 100
Las Vegas, NV 89117
Phone (702) 304-0091
1941 Jefferson St
North Las Vegas, NV 89030
1941 Jefferson St
#105
North Las Vegas, NV 89030
Practitioners & affiliated clinicians
Practitioners 79
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.
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1629234323
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1427288265
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1528019163
-
- Physician Assistant
- Las Vegas, NV
- NPI 1497624647
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1053365437
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1154556314
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1427276211
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1063538544
-
- Diagnostic Radiology Physician
- Las Vegas, NV
- NPI 1003805045
-
- Diagnostic Radiology Physician
- Wellington, FL
- NPI 1225076219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687910400000",
"number": "1952353591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30077",
"address_2": "DEPT 306",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841300077",
"telephone_number": "702-228-0031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5495 S RAINBOW BLVD STE 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891181872",
"telephone_number": "702-228-0031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PUEBLO MEDICAL IMAGING, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-16",
"last_updated": "2023-06-28",
"certification_date": "2023-06-28",
"status": "A",
"authorized_official_last_name": "NIELSEN",
"authorized_official_first_name": "MICAH",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "702-477-0772",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NV",
"identifier": "NV1651",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100500056",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.