PROACTIVE IMAGING LLC (NPI# 1619970910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619970910 |
| Entity Type | Organization |
| Organization Name | PROACTIVE IMAGING LLC |
| Other Organization Name | MINNESOTA RADIOLOGY |
| Practice Address |
4000 W 76th St Ste 100 Edina MN 55435-5104 |
| Practice Telephone | 9528537226 |
| Practice Fax Number | 9528317555 |
| Mailing Telephone | 9528537226 |
| Mailing Fax Number | 9528317555 |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2008-10-02 |
| Authorized Official Name | ANGEL L SOTO (PRESIDENT) |
| Authorized Official Telephone | 9545592421 |
| Authorized Official Credential | PRESIDENT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
540 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICARE RAILROAD | P00053758 | 01 |
| MN | OFFICE OF WORK COMP. | 22030077 | 01 |
| Other Name | Type Code |
|---|---|
| Minnesota Radiology | Doing Business As Name - Organization |
| Street Address |
4000 W 76TH ST STE 100 |
| City | EDINA |
| State | MN |
| Zip Code | 55435-5104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821091125 | National Radiology Pllc | Radiology | 4000 W 76th St, Ste 160, Edina, MN 55435-5104 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| 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 |
|---|---|---|---|---|
| 1417164005 | Rochelle A Wolfe | Radiology | 4100 Minnesota Dr Ste 310, Edina, MN 55435-5417 | 2007-05-16 |
| 1699794792 | David Albert Swanson | Radiology | 5720 Long Brake Trl, Edina, MN 55439-2620 | 2006-07-19 |
| 1407849391 | Robert A Pollock | Radiology | 7505 Metro Blvd, Ste 400, Edina, MN 55439 | 2005-08-25 |
| 1083022198 | Andrew Tyler Miller | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439-3010 | 2014-08-01 |
| 1386063295 | Amanda Baillargeon | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439-3010 | 2014-04-08 |
| 1912347493 | Brenda Joy Hyde | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439-3010 | 2013-06-28 |
| 1609214576 | Kayleen Jahangir | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439 | 2013-06-12 |
| 1063859288 | Mohammad Abbas Kassir | Radiology | 7505 Metro Blvd, Ste 400, Edina, MN 55439-3010 | 2013-05-29 |
| 1609131887 | Jillian Ann Karow | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439-3010 | 2012-07-12 |
| 1356609937 | Samuel J Hauck | Radiology | 7505 Metro Blvd Ste 400, Edina, MN 55439 | 2012-05-02 |
| Find all providers in EDINA | ||||
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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.