Active NPI
Keith Mussog, RT (R)
- Radiography Radiologic Technologist
- Dallas, TX
National Provider Identifier
1992132609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiography Radiologic Technologist
- License
- 96693
- Practice address
- 13154 Coit Rd
Dallas, TX 75240-5773 - Phone
- (443) 235-4991
- NPI assigned
- Sep 26, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiography Radiologic Technologist | 2471C3402X | 96693 | TX | Primary |
Addresses
Primary practice location
13154 Coit Rd
Dallas, TX 75240-5773
Mailing address
12573 Granite Falls TRL
Frisco, TX 75035-0086
Phone (443) 235-4991
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 457059 | Other | THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGIST | |
| 96693 | Other | TX | CERTIFIED MEDICAL RADIOLOGIC TECHNOLOGIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96693 | TX | MD | Radiography Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471305600000",
"number": "1992132609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12573 GRANITE FALLS TRL",
"city": "FRISCO",
"state": "TX",
"postal_code": "750350086",
"telephone_number": "443-235-4991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13154 COIT RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752405773",
"telephone_number": "443-235-4991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSSOG",
"first_name": "KEITH",
"name_prefix": "Mr.",
"credential": "RT (R)",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-26",
"last_updated": "2016-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "2471C3402X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Radiography",
"state": "TX",
"license": "96693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGIST",
"identifier": "457059",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED MEDICAL RADIOLOGIC TECHNOLOGIST",
"identifier": "96693",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.