Basic Information
| Provider Information | |||||||||
| NPI: | 1487690335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMAGING CONSULTANTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIR STE 400 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 761 WORCESTER RD | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017015224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662455995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/22/2006 | ||||||||
| NPIReactivationDate: | 11/26/2007 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BLOOM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9785522600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 440327 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0208X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
ID Information
| ID | Type | State | Issuer | Description | 036769 | 01 | MA | BCBS | OTHER | 785146 | 01 | MA | CONNECTICARE | OTHER | 0008850 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 36984 | 01 | MA | FALLON | OTHER | 0421008 | 01 | MA | CIGNA / HEALTHSOURCE | OTHER | 1529871 | 05 | MA | MEDICAID | P00021368 | 01 | MA | RAILROAD MEDICARE | OTHER | 346646400 | 01 | MA | U.S. DEPT OF LABOR OWCP | OTHER | 626264 | 01 | MA | HARVARD PILGRIM HLTH CARE | OTHER | 713587 | 01 | MA | TUFTS/ SECURE HORIZONS | OTHER | 81020 | 01 | MA | AETNA | OTHER |