NPIMap

Organization Active NPI

Pro Rad, Inc

  • Diagnostic Radiology Physician
  • Bryan, OH
National Provider Identifier
1962470484
Registry record updated Jul 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PRO RAD, INC
Practice address
433 W High St
Bryan, OH 43506-1690
Phone
(419) 636-1131
NPI assigned
Mar 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2011

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

Authorized official

Name
John P Ewonus, D.O.NPI 1437127040
Title
President
Phone
(419) 636-1131

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

433 W High St
Bryan, OH 43506-1690

Mailing address

PO Box 1046
Lima, OH 45802-1046
Phone (419) 224-5707

Other identifiers 4

IdentifierTypeStateIssuer
000000167003OtherOHANTHEM BCBS
2151595MedicaidOH
128014000OtherUS DEPT OF LABOR WORKERS
029599900OtherOHFEDERAL BLACK LUNG

National Provider Directory

National Provider Directory

Locations

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

324 W High St
Bryan, OH 43506
Phone (419) 636-2525

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1962470484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1046",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458021046",
            "telephone_number": "419-224-5707",
            "fax_number": "419-229-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061690",
            "telephone_number": "419-636-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO RAD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "EWONUS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-636-1131",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000167003",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2151595",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR WORKERS",
            "identifier": "128014000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "029599900",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.