NPIMap

Organization Active NPI

Advanced Imaging of Gadsden LLC

  • Diagnostic Radiology Physician
  • Gadsden, AL
National Provider Identifier
1972615581
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
17729 Issued in AL
Legal business name
ADVANCED IMAGING OF GADSDEN LLC
Practice address
820 S 4TH Street
Gadsden, AL 35901-5223
Phone
(256) 549-0008
Fax
(256) 549-0401
NPI assigned
Aug 31, 2006
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Kennon H Hager, MDNPI 1609857291
Title
Owner/Physician
Phone
(256) 549-0008

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 17729 AL Primary

Addresses

Primary practice location

820 S 4TH Street
Gadsden, AL 35901-5223

Mailing address

820 South 4TH Street
Gadsden, AL 35901-5223
Phone (256) 549-0008

Other identifiers 3

IdentifierTypeStateIssuer
529921610MedicaidAL
DC6981OtherALMEDICARE RAILROAD
113978MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041112000791 AL Part B Supplier - Clinic/Group Practice 6204890916 Receives reassigned benefits from 10 practitioners
Practice locations: Gadsden, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D1079462Advanced Imaging of Gadsden820 S 4TH Street, Gadsden, AL 35901Certificate of waiverJan 30, 2028

National Provider Directory

National Provider Directory

Locations

820 S 4th St
Gadsden, AL 35901
Phone (256) 543-0008

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1972615581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 SOUTH 4TH STREET",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015223",
            "telephone_number": "256-549-0008",
            "fax_number": "256-549-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S 4TH STREET",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015223",
            "telephone_number": "256-549-0008",
            "fax_number": "256-549-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED IMAGING OF GADSDEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "HAGER",
        "authorized_official_first_name": "KENNON",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "256-549-0008",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AL",
            "license": "17729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529921610",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC6981",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113978",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.