MID-AMERICA IMAGING LLC (NPI# 1730147737) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730147737 |
| Entity Type | Organization |
| Organization Name | MID-AMERICA IMAGING LLC |
| Practice Address |
1512 N Green Mount Rd O Fallon IL 62269 |
| Practice Telephone | 6186240100 |
| Practice Fax Number | 6186240102 |
| Mailing Telephone | 6186240100 |
| Mailing Fax Number | 6186240102 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2017-05-08 |
| Authorized Official Name | PAUL M SCHROEDER (TREASURER) |
| Authorized Official Telephone | 6186240100 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1200X |
Clinic/Center Specialization: Magnetic Resonance Imaging (MRI) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GROUP HEALTH PLAN | 25607 | 01 | |
| MO | BLUE CROSS BLUE SHIELD | 194352 | 01 |
| IL | BLUE CROSS BLUE SHIELD | 8221407 | 01 |
| IL | RR MEDICARE | 470001974 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316099989 | Mid-america Imaging LLC | Spec/Tech, Cardiovascular | 1711 Taylor St, Lexington, MO 64067-1153 | 2007-01-17 |
| Street Address |
1512 N GREEN MOUNT RD |
| City | O FALLON |
| State | IL |
| Zip Code | 62269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891787040 | Dorrie C Tredway | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-2083 | 2005-08-15 |
| 1487142022 | Vituity - Illinois Auc LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269 | 2018-04-30 |
| 1295239747 | Chandler Sparks | Student in an Organized Health Care Education/Training Program | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2018-03-20 |
| 1649660200 | Tara Topper | Nurse Practitioner | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2015-02-03 |
| 1851715692 | Infinity-meds LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2014-02-14 |
| 1639319387 | David Edward Bereda | Family Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2009-02-20 |
| 1790945103 | Ob Gyn Care LLC | Surgery | 1512 N Green Mount Rd, Suite 107, O Fallon, IL 62269-1953 | 2008-06-10 |
| 1053587402 | Amy Marie Buck | Nurse Practitioner | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-05-06 |
| 1932377249 | Stephen Jubinski Jr. | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-1953 | 2008-02-20 |
| 1003091570 | St. Elizabeth Hospital | Clinic/Center | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 261QM1200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Magnetic Resonance Imaging (MRI) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295385284 | St. Elizabeth's Hospital of The Hospital Sisters of The Third Order | Clinic/Center | 1512 N Green Mount Rd Ste 103, O Fallon, IL 62269-2083 | 2019-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326516584 | Loretto Hospital | Clinic/Center | 7431 S East End Ave, Floor 1st Suite 2, Chicago, IL 60649-3611 | 2018-11-06 |
| 1164969838 | Smart Choice Mri, LLC | Clinic/Center | 850 N Milwaukee Ave Ste 103, Vernon Hills, IL 60061-1553 | 2017-01-19 |
| 1417491655 | Smart Choice Mri LLC | Clinic/Center | 757 E Boughton Rd, Bolingbrook, IL 60440-2281 | 2016-12-07 |
| 1205379229 | Fulton Market Mri LLC | Clinic/Center | 559 W Kinzie St, Chicago, IL 60654-5702 | 2016-11-22 |
| 1477003267 | Smart Choice Mri, LLC | Clinic/Center | 2752 Us Highway 34, Oswego, IL 60543 | 2016-10-05 |
| 1104376987 | Smart Choice Mri, LLC | Clinic/Center | 2830 S Highland Ave Unit 9, Lombard, IL 60148-7135 | 2016-10-05 |
| 1922461664 | Smart Choice Mri, LLC | Clinic/Center | 1850 N Clybourn Ave, Chicago, IL 60614-8048 | 2016-03-31 |
| 1144695511 | Smart Choice Mri, LLC | Clinic/Center | 3560 Touhy Avenue, Skokie, IL 60076-6218 | 2015-12-10 |
| 1598130635 | Smart Choice Mri LLC | Clinic/Center | 1406 N Meacham Rd, Schaumburg, IL 60173-4808 | 2015-12-01 |
| 1891129599 | Smart Scan Mri, LLC | Clinic/Center | 350 S. Greenleaf, Suite 401, Gurnee, IL 60031 | 2013-08-29 |
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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.