FT. JESSE IMAGING CENTER LLC (NPI# 1104333491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104333491 |
| Entity Type | Organization |
| Organization Name | FT. JESSE IMAGING CENTER LLC |
| Practice Address |
2200 Fort Jesse Rd Normal IL 61761-6286 |
| Mailing Address |
840 Crescent Centre Dr Ste 200 Franklin TN 37067-4652 |
| Practice Telephone | 3094545552 |
| Mailing Telephone | 6152612306 |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-01-08 |
| Authorized Official Name | WILLIAM P BAKER (SECRETARY) |
| Authorized Official Telephone | 3094545552 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 46015604001 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245287143 | Ft. Jesse Imaging Center LLC | Clinic/Center | 2200 Fort Jesse Rd, Suite 130, Normal, IL 61761-6286 | 2006-05-27 |
| Street Address |
2200 FORT JESSE RD |
| City | NORMAL |
| State | IL |
| Zip Code | 61761-6286 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538168786 | Edward H. Kolb | Orthopaedic Surgery | 2200 Fort Jesse Rd, Suite 250, Normal, IL 61761-6286 | 2005-07-19 |
| 1245688209 | Lindsay Connor | Nurse Practitioner | 2200 Fort Jesse Rd, Suite 110, Normal, IL 61761-6286 | 2016-06-01 |
| 1366837676 | Emily Forney | Physical Therapist | 2200 Fort Jesse Rd, Suite 240, Normal, IL 61761-6286 | 2015-04-02 |
| 1134529555 | Traci Kissinger | Physical Therapist | 2200 Fort Jesse Rd, Suite 250, Normal, IL 61761-6286 | 2014-09-04 |
| 1811323975 | Rachel E Bauman | Dietitian, Registered | 2200 Fort Jesse Rd, Suite 250, Normal, IL 61761-6286 | 2013-09-20 |
| 1295088391 | Jennifer Alice Berkley | Nurse Practitioner | 2200 Fort Jesse Rd, Normal, IL 61761-6286 | 2012-10-26 |
| 1063765303 | Mallory R Hippler | Counselor | 2200 Fort Jesse Rd, Normal, IL 61761-6286 | 2012-10-24 |
| 1083962500 | Jessica Johann | Nurse Practitioner | 2200 Fort Jesse Rd, 110, Normal, IL 61761-6286 | 2012-08-15 |
| 1003163379 | Jason N Richards | Occupational Therapist | 2200 Fort Jesse Rd, Normal, IL 61761-6286 | 2012-08-06 |
| 1144597667 | Orthoworks, S.c. | Orthopaedic Surgery | 2200 Fort Jesse Rd, Suite 250, Normal, IL 61761-6286 | 2011-11-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681796 | Brittany Nicole Mekley | Nurse Practitioner | 201 N. University, Normal, IL 61761 | 2020-08-28 |
| 1679108971 | Krystal Halliday | Occupational Therapist | 1815 N Towanda Barnes Rd, Normal, IL 61761 | 2020-03-06 |
| 1265915474 | Laine E Burek | Nurse Practitioner | 1765 Bradford Ln., Normal, IL 61761 | 2018-09-13 |
| 1801389986 | Ashley Michelle James | Specialist/Technologist | 347 S. University St, Normal, IL 61761 | 2018-06-12 |
| 1447750708 | Shelley R. Ruch | Specialist/Technologist, Other | 1604 Visa Drive, Ste 1, Normal, IL 61761 | 2018-02-13 |
| 1497275069 | Mclean County Nursing Home | Non-emergency Medical Transport (VAN) | 901 N. Main St, Normal, IL 61761 | 2017-06-23 |
| 1235673666 | Megan Threm | Registered Nurse | 900 Franklin Ave Community Health Care Clinic, Normal, IL 61761 | 2016-12-04 |
| 1437513553 | Tiesha Smith | Specialist | 1800 Rockingham Dr, Apt 1d, Normal, IL 61761 | 2016-04-06 |
| 1285031658 | New Day Recovery | Community/Behavioral Health | 402 Summit, Normal, IL 61761 | 2014-12-01 |
| 1174927701 | Alyssa Marie Bruck | Occupational Therapist | 700 N Walnut St, Normal, IL 61761 | 2014-10-10 |
| Find all providers in zip 61761 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063627214 | Amit Vyas | Radiology | 2200 Fort Jesse Road, Ste. 280, Normal, IL 61761-6289 | 2007-05-11 |
| 1114169893 | Pooria Javadi | Radiology | 2200 Fort Jesse Rd, Ste 280, Normal, IL 61761-6286 | 2009-03-27 |
| 1386683076 | Kendall L Wong | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-06 |
| 1316986466 | William L Ray | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-05 |
| 1265471486 | Jonathan M Foss | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-05 |
| 1942249131 | Adrian M Cordoba | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-05 |
| 1083653117 | Chung H Lee | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-05 |
| 1912946153 | Richard P Puckett | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-06-05 |
| 1972559912 | William E Cooley | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-05-25 |
| 1043266018 | Carlos P Capati | Radiology | 2200 Fort Jesse Rd, Suite 280, Normal, IL 61761-6286 | 2006-05-25 |
| Find all providers in NORMAL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.