SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C. (NPI# 1790814465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790814465 |
| Entity Type | Organization |
| Organization Name | SPRINGFIELD NEUROLOGICAL INSTITUTE, L.L.C. |
| Other Organization Name | SNI IMAGING |
| Practice Address |
2900 S National Ave Springfield MO 65804-3634 |
| Mailing Address |
Po Box 4024 Springfield MO 65808-4024 |
| Practice Telephone | 4178853888 |
| Practice Fax Number | 4178817638 |
| Mailing Telephone | 4178853888 |
| Mailing Fax Number | 4178817638 |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2011-04-18 |
| Authorized Official Name | MARQUITTA A. WINGO (PROVIDER ENROLLMENT/ADMINISTRATIVE) |
| Authorized Official Telephone | 4178853888 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RM1200X |
Internal Medicine Specialization: Magnetic Resonance Imaging (MRI) |
Allopathic & Osteopathic Physicians | ||
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2085N0700X |
Radiology Specialization: Neuroradiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | DEPARTMENT OF LABOR OWCP | 141320300 | 01 |
| MO | ENCOMPAS | 37110 | 01 |
| AR | 143549002 | 05 | |
| MO | GTE VERISON DATA SERVICES | 502277007 | 01 |
| AR | ARKANSAS BC/BS | 5C687 | 01 |
| AR | HEALTH ADVANTAGE | 5C687 | 01 |
| Other Name | Type Code |
|---|---|
| SNI Imaging | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093088593 | Springfield Neurological Institute, L.L.C. | Neurological Surgery | 3215 N Northhills Blvd, Fayetteville, AR 72703-4424 | 2012-02-14 |
| 1306978911 | Springfield Neurological Institute, L.L.C. | Prosthetic/Orthotic Supplier | 2900 S National Ave, Springfield, MO 65804-3634 | 2007-03-09 |
| Street Address |
2900 S NATIONAL AVE |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-3634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932192895 | Jennifer Marie Probstfield | Specialist/Technologist | 2900 S National Ave, Springfield, MO 65804-3634 | 2005-08-25 |
| 1407376619 | Lauren Branham | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2017-06-20 |
| 1174067631 | Lester E Cox Medical Centers | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2016-12-16 |
| 1639529597 | Whitney Davis | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2016-06-21 |
| 1245680107 | James Ganus | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2016-06-21 |
| 1467828202 | Ibrahim Abdelhamid Alahmad | Nurse Practitioner | 2900 S National Ave, Springfield, MO 65804-3634 | 2015-08-17 |
| 1437565223 | Marlana Marie Bray | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2014-07-01 |
| 1598004152 | Todd Phillip Decarlis | Physician Assistant | 2900 S National Ave, Springfield, MO 65804-3634 | 2013-02-01 |
| 1871892083 | Alyse Megan Fields | Dietitian, Registered | 2900 S National Ave, Springfield, MO 65804-3634 | 2011-03-28 |
| 1992018287 | Jennifer Snyder | Family Medicine | 2900 S National Ave, Springfield, MO 65804-3634 | 2010-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| 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 |
|---|---|---|---|---|
| 1528475050 | Bachir Zoghbi | Radiology | 3801 S National Ave, Springfield, MO 65807-5210 | 2014-07-16 |
| 1063674216 | Bryan Su-hyun Jeun | Radiology | 3801 S National Ave, Springfield, MO 65807-5210 | 2008-06-30 |
| 1386817294 | Michael Shane Walters | Radiology | 1001 E Primrose St, Springfield, MO 65807-5155 | 2008-04-11 |
| 1114033396 | Jason L. Port | Radiology | 3640 Main St, Suite 101, Springfield, MA 01107-1145 | 2006-08-21 |
| 1992818991 | Matthew J. Kuhn | Radiology | 800 E Carpenter St, Department of Radiology, Springfield, IL 62702-5324 | 2006-08-16 |
| 1083675235 | Bryan Keith Hall | Radiology | 3801 S National Ave, Springfield, MO 65807-5210 | 2006-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629023239 | Sharon K Wallace | Radiology | 70 Doctors' Park, Cape Girardeau, MO 63703 | 2006-05-23 |
| 1386115715 | Ayman Mohamed Nada | Radiology | 1 Hospital Dr, Columbia, MO 65212-0001 | 2018-12-11 |
| 1457832404 | Sudhir Bhimaniya | Radiology | 216 S Kingshighway Blvd, Saint Louis, MO 63110-1026 | 2018-08-28 |
| 1902293285 | Kasra Rahbar | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-04-23 |
| 1275947012 | Rahul Pradeep Deolankar | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-06-19 |
| 1073923223 | John Td Vu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-04-28 |
| 1477978534 | Carlos Leiva Salinas | Radiology | 1 Hospital Dr, Columbia, MO 65212-0001 | 2014-02-26 |
| 1811330954 | Michael T Bayona | Radiology | 100 Mercy Way, Joplin, MO 64804-4524 | 2013-04-08 |
| 1952663270 | Rami W Eldaya | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2012-06-12 |
| 1992064521 | Ritu Bordia | Radiology | 1201 S Grand Blvd, Saint Louis, MO 63104-1016 | 2012-05-16 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
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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.