PROVIDENCE DIAGNOSTIC IMAGING, INC. (NPI# 1609978170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609978170 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE DIAGNOSTIC IMAGING, INC. |
| Practice Address |
271 Carew St Springfield MA 01104-2377 |
| Practice Telephone | 4137489200 |
| Mailing Telephone | 4137489200 |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2015-07-01 |
| Authorized Official Name | DR. GREGORY E. BLACKMAN (PRESIDENT) |
| Authorized Official Telephone | 4137489200 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 2085N0700X |
Radiology Specialization: Neuroradiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CONNECTICARE | 774327 | 01 | |
| MA | AETNA/US HEALTHCARE | 783230 | 01 |
| CT | 003126358 | 05 | |
| MA | NETWORK HEALTH | 98133101 | 01 |
| MA | TUFTS | 755228 | 01 |
| RAILROAD MEDICARE | CA7920 | 01 | |
| MA | 9776559 | 05 | |
| MA | BMC HEALTHNET PLAN | 000000025268 | 01 |
| US DEPARTMENT OF LABOR | 102940700 | 01 | |
| MA | BLUE CROSS/BLUE SHIELD | M16237 | 01 |
| EVERCARE | 1601748 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | Providence Diagnostic Imaging, Inc. | Attn: Account Manager, 291 Moody St., Ludlow, MA 01056 |
| Street Address |
271 CAREW ST |
| City | SPRINGFIELD |
| State | MA |
| Zip Code | 01104-2377 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013911957 | Jeffrey Lawrence Friedman | Specialist | 271 Carew St, Springfield, MA 01104-2377 | 2005-06-09 |
| 1700401213 | Laura Quink | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2020-06-10 |
| 1235784943 | Alyssa L. Fleurent | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2019-08-08 |
| 1962061929 | Emily Mckenna Clough | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2019-06-12 |
| 1508425109 | Christopher Clark | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2019-06-07 |
| 1851955256 | Bernard Sanvie | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2019-05-01 |
| 1669036737 | Adfinitas Health At The Mercy Hospital Pllc | Hospitalist | 271 Carew St, Springfield, MA 01104-2377 | 2019-04-24 |
| 1326502238 | Woodland Anesthesiology Associates, P.C. | Anesthesiology | 271 Carew St, Springfield, MA 01104-2377 | 2019-01-24 |
| 1912480351 | Sarah Gagnon | Nurse Practitioner | 271 Carew St, Springfield, MA 01104-2377 | 2018-09-12 |
| 1922580984 | Samantha Abraham | Physician Assistant | 271 Carew St, Springfield, MA 01104-2377 | 2018-09-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346727567 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2155 Main Street, Suite 131/133, Springfield, MA 01104 | 2018-07-20 |
| 1508385618 | Demetrios Sotiropoulos | Physician Assistant | 175 Carew St Ste 250, Springfield, MA 01104 | 2017-09-11 |
| 1114382942 | Rosana Rivera-delgado | Psychologist | 4017 Liberty St, Springfield, MA 01104 | 2015-12-21 |
| 1417363516 | Springfield Family Pharmacy, Inc | Pharmacy | 175 Carew St, Suite 100, Springfield, MA 01104 | 2014-07-09 |
| 1437588837 | Ariam Ivette Pena | Counselor | 85 St. George Road, Springfield, MA 01104 | 2013-11-06 |
| 1891124293 | Ana E. Centeno | Counselor | 85 St. George Road., Springfield, MA 01104 | 2013-11-06 |
| 1275962003 | Swany Matos | Counselor | 2155 Main St., Springfield, MA 01104 | 2013-11-02 |
| 1184053910 | Claudia Eileen Quesada | Counselor | 2155 Main Street and St. George Road, The Gandara Center, Springfield, MA 01104 | 2013-11-02 |
| 1194023044 | Hungry Hill Family Practice | Clinic/Center | 776 Liberty Street, Hungry Hill Family Practice, Springfield, MA 01104 | 2011-03-02 |
| 1710115308 | Michael Allen Roche | Counselor | 332 Bernie Ave, Center for Human Development, Springfield, MA 01104 | 2009-06-23 |
| Find all providers in zip 01104 | ||||
| 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 |
|---|---|---|---|---|
| 1407389596 | Medical Mile Imaging | Radiology | 3905 E Windsmore Dr, Springfield, MO 65802 | 2017-04-06 |
| 1154738961 | Allison Kate Retzer | Radiology | 701 N 1st Box 101, Springfield, IL 62781-0001 | 2014-07-14 |
| 1134552821 | Clinical Radiologists, S.c. | Radiology | 2812 Pat Tillman Dr, Springfield, IL 62711-6410 | 2013-08-16 |
| 1700199668 | Telerad of Mo Account Management, LLC | Radiology | 5117 S. Neffleton Ave, Springfield, MO 65810 | 2010-07-21 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| 1316108434 | Michael C Snyder | Radiology | 2201 Greenside Dr, Springfield, IL 62704-3245 | 2008-06-20 |
| 1245416536 | Mary T Peter | Radiology | Springfield Radiologists St Johns Hospital, 800 E. Carpenter Street, Springfield, IL 62769-0001 | 2008-01-16 |
| 1437361060 | Kal Dulaimy | Radiology | 1350 Main Street Suite 1007, Radiology and Imaging, Inc., Springfield, MA 01103-0000 | 2007-05-04 |
| 1265654164 | Nzeadibenma O Uzochukwu | Radiology | 800 Carpenter St, Springfield, IL 62769-0001 | 2007-05-02 |
| 1396865838 | Charles X Stricker | Radiology | 4303 E Lori Lei Ct, Springfield, MO 65809-3501 | 2007-03-29 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 01104 |
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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.