NPIMap

Organization Active NPI

Steward Pet Imaging, LLC

  • Mobile Radiology Clinic/Center
  • Ayer, MA
National Provider Identifier
1992076632
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
License
4NNJ Issued in MA
Legal business name
STEWARD PET IMAGING, LLC
Practice address
200 Groton Rd
Ayer, MA 01432-1168
Phone
(978) 794-8000
NPI assigned
Jan 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Authorized official

Name
Mr. Robert E Guyon Jr.
Title
Ceo
Phone
(617) 419-4707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Radiology Clinic/Center 261QR0208X 4NNJ MA Primary

Addresses

Primary practice location

200 Groton Rd
Ayer, MA 01432-1168

Mailing address

500 Boylston St
Boston, MA 02116-3740
Phone (877) 877-8455

Other names 1

  • Steward PET Imaging, LLC at Nashoba Valley Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041206000621 MA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7214831056 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norwood, MA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1992076632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 BOYLSTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021163740",
            "telephone_number": "877-877-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GROTON RD",
            "city": "AYER",
            "state": "MA",
            "postal_code": "014321168",
            "telephone_number": "978-794-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWARD PET IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "GUYON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "617-419-4707",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "MA",
            "license": "4NNJ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steward PET Imaging, LLC at Nashoba Valley Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ayer, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; 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.