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FT. JESSE IMAGING CENTER LLC
NPI 1104333491
Radiology - Diagnostic Radiology in Normal, IL

Active since January 08, 2018CLIA 14D1090197 · Waiver
2200 FORT JESSE RD, NORMAL, IL 61761(309) 454-5552 Get Directions Write a Review

NPPES record last updated: October 21, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ft. Jesse Imaging Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FT. JESSE IMAGING CENTER LLC (NPI 1104333491) is a healthcare organization registered as a diagnostic radiology in Normal, Illinois and active in the NPI registry since January 2018. The organization holds a CLIA Waiver certificate valid through February 18, 2027 and lists Amy Stout, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1104333491
Entity TypeOrganization
Primary Taxonomy2085R0202X
Legal Business NameFT. JESSE IMAGING CENTER LLC
Location Address2200 FORT JESSE RDNormal, IL 61761-6286
Mailing Address840 Crescent Centre Dr Ste 200Franklin, TN 37067-4652 · (615) 261-2306
Phone(309) 454-5552
Organization SubpartNo
Authorized OfficialAmy StoutPresident/ceo · (615) 261-2306
Enumeration DateJanuary 8, 2018
Last NPPES UpdateOctober 21, 2024
NPPES CertifiedOctober 21, 2024
✔ NPI 1104333491 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
2200 FORT JESSE RD, Normal, IL 61761
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Other Identifiers 1

Medicaid46015604001IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1090197

Fort Jesse Imaging Center · Normal, IL
Active · expires Feb 18, 2027
CLIA Number14D1090197
Laboratory TypeOther
Certificate Effective DateFebruary 19, 2025
Certificate Expiration DateFebruary 18, 2027
Laboratory DirectorNaveed Yousuf
Laboratory Phone(309) 454-5552
Laboratory LocationFort Jesse Imaging Center2200 Fort Jesse Rd, Suite 120, Normal, IL 61761
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBIN POSTON OT
Occupational Therapist
2200 FORT JESSE RD, SUITE 250
NORMAL, IL 61761
McLean County (309) 454-1616
MR. JASON N RICHARDS OT
Occupational Therapist
2200 FORT JESSE RD
NORMAL, IL 61761
McLean County (309) 888-9800
DR. DANIEL L HA M.D.
Radiology (Body Imaging)
2200 FORT JESSE RD, SUITE 280
NORMAL, IL 61761
McLean County (309) 452-1788
DR. AJAY R MALPANI M.D.
Radiology (Nuclear Radiology)
2200 FORT JESSE RD, SUITE 280
NORMAL, IL 61761
McLean County (309) 452-1788
DR. CARLOS P CAPATI M.D.
Radiology (Diagnostic Radiology)
2200 FORT JESSE RD, SUITE 280
NORMAL, IL 61761
McLean County (309) 452-1788
DR. DAVID KOCH M.D.
Radiology (Body Imaging)
2200 FORT JESSE RD, SUITE 280
NORMAL, IL 61761
McLean County (309) 452-1788
MS. MALLORY R HIPPLER COUNSELOR
Counselor (Professional)
2200 FORT JESSE RD
NORMAL, IL 61761
McLean County (309) 661-6290
JESSICA JOHANN
Nurse Practitioner
2200 FORT JESSE RD, 110
NORMAL, IL 61761
McLean County (309) 661-6290

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ft. Jesse Imaging Center LLC's NPI number?

The NPI number for Ft. Jesse Imaging Center LLC is 1104333491. It was assigned to this organization in the NPPES registry on January 8, 2018.

Where is Ft. Jesse Imaging Center LLC located?

Ft. Jesse Imaging Center LLC is located at 2200 Fort Jesse Rd, Normal, IL 61761. The listed phone number is (309) 454-5552.

What is Ft. Jesse Imaging Center LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Does Ft. Jesse Imaging Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1090197) is associated with this NPI, valid through February 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ft. Jesse Imaging Center LLC was last updated on October 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.