Elevated Diagnostic Imaging and Pain Management Center LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

261QP3300X Issued in IN

Legal business name

ELEVATED DIAGNOSTIC IMAGING AND PAIN MANAGEMENT CENTER LLC

Practice address

1642 Olive Branch Park LN
Greenwood, IN 46143-6447

Phone

(317) 504-1665

NPI assigned

Apr 12, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Lamont Johnson, RT

Title

Ceo/Owner

Phone

(317) 504-1665

Specialties & licenses 5

Addresses

Other names 1

• EDI llc. Other name

Locations

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

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271030400000",
    "number": "1972829372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5045 BROOKSTONE LN",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462685420",
            "telephone_number": "317-504-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 OLIVE BRANCH PARK LN",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461436447",
            "telephone_number": "317-504-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATED DIAGNOSTIC IMAGING AND PAIN MANAGEMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-12",
        "last_updated": "2010-04-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "317-504-1665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RT"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "IN",
            "license": "261QM1200X",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IN",
            "license": "261QM1300X",
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IN",
            "license": "261QP1100X",
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "IN",
            "license": "261QP3300X",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "IN",
            "license": "261QR0200X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDI llc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pain Clinic/Center in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Pain Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.