NPIMap

Organization Active NPI

Three Rivers Radiology Associates, PC

  • Diagnostic Radiology Physician
  • Grants Pass, OR
National Provider Identifier
1962444240
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
THREE RIVERS RADIOLOGY ASSOCIATES, PC
Practice address
500 SW Ramsey Ave
Grants Pass, OR 97527-5554
Phone
(541) 472-7140
NPI assigned
Jun 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Authorized official

Name
Mike Tripp
Title
Administrator
Phone
(541) 471-4485

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

500 SW Ramsey Ave
Grants Pass, OR 97527-5554

Mailing address

PO Box 1750
Grants Pass, OR 97528-0148
Phone (541) 471-4485

Other identifiers 1

IdentifierTypeStateIssuer
189449MedicaidOR

Other names 1

  • Advanced Imaging Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318000644 OR Part B Supplier - Clinic/Group Practice 9830089267 Receives reassigned benefits from 6 practitioners
Practice locations: Grants Pass, OR

National Provider Directory

National Provider Directory

Locations

1215 NE 7th St
Ste E
Grants Pass, OR 97526
Phone (541) 471-4485

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1962444240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1750",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975280148",
            "telephone_number": "541-471-4485",
            "fax_number": "541-471-4486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275554",
            "telephone_number": "541-472-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS RADIOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-471-4485"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189449",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Imaging Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Imaging Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; 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.