NPIMap

Organization Active NPI

Innovative Medical Imaging, PLLC

  • Diagnostic Radiology Physician
  • Twin Falls, ID
National Provider Identifier
1962015776
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
INNOVATIVE MEDICAL IMAGING, PLLC
Practice address
512 Pole Line Rd Ste 1
Twin Falls, ID 83301-6367
Phone
(208) 735-5555
Fax
(208) 735-5556
NPI assigned
Aug 31, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Stephan G Thiede, MDNPI 1346277399
Title
Authorized Official
Phone
(541) 334-7550

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

512 Pole Line Rd Ste 1
Twin Falls, ID 83301-6367

Mailing address

PO Box 1614
Evansville, IN 47706-0016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201030001557 ID Part B Supplier - Clinic/Group Practice 1951711050 Receives reassigned benefits from 12 practitioners
Practice locations: Filer, ID; Twin Falls, ID
O20231213003232 OR Part B Supplier - Clinic/Group Practice 1951711050 Receives reassigned benefits from 24 practitioners
Practice locations: Eugene, OR

National Provider Directory

National Provider Directory

Locations

512 Pole Line Rd
Ste 1
Twin Falls, ID 83301
Phone (208) 735-5555

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1962015776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1614",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477060016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 POLE LINE RD STE 1",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016367",
            "telephone_number": "208-735-5555",
            "fax_number": "208-735-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL IMAGING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-31",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "THIEDE",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "541-334-7550",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.