NPIMap

Organization Active NPI

Clinical Radiologists, S.C.

  • Diagnostic Radiology Physician
  • Boulder, CO
National Provider Identifier
1992114714
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
042000749 Issued in IL
Legal business name
CLINICAL RADIOLOGISTS, S.C.
Practice address
295 Fox Dr
Boulder, CO 80303-3529
Phone
(952) 595-5296
NPI assigned
Aug 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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

Authorized official

Name
Thomas C Dickerson
Title
Chief Executive Officer
Phone
(217) 222-9302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 042000749 IL Primary

Addresses

Primary practice location

295 Fox Dr
Boulder, CO 80303-3529

Mailing address

3050 Montvale Dr
Springfield, IL 62704-4290
Phone (217) 726-8096

National Provider Directory

National Provider Directory
Tax ID family
Clinical Radiologists SC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1992114714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 MONTVALE DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044290",
            "telephone_number": "217-726-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 FOX DR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803033529",
            "telephone_number": "952-595-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL RADIOLOGISTS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "217-222-9302"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "042000749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; 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.