Direct Radiology PLLC

NPI 1144572173ActiveOrganization· Radiology, Diagnostic Radiology· Bothell, WA

Radiology, Diagnostic Radiology in Bothell, Washington, registered in NPPES in October 2012. The authorized official on file is Kyle J. Henneberry, MD, Chief Medical Officer. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.

Overview

NPI	1144572173
Status	Active
Entity type	Organization
NPI issued	Oct 15, 2012
Last updated in NPPES	Jul 25, 2023
Certified by provider	Jul 25, 2023

Specialties and licenses

Taxonomy	Code	License	State
Radiology, Diagnostic Radiology Primary	2085R0202X	—	—

About license numbers in NPPES

Exclusion screening

List	Result	Details
HHS-OIG LEIE · Oct 9, 2026	No match	Checked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026	No match	—
New York OMIG · Nov 10, 2026	No match	—
Ohio Medicaid · Nov 10, 2026	No match	—
Pennsylvania Medicheck · Nov 10, 2026	No match	—
Washington HCA · Nov 10, 2026	No match	—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)	Enrolled Part B Supplier - Clinic/Group Practice (CA); Part B Supplier - Clinic/Group Practice (CO); Part B Supplier - Clinic/Group Practice (FL); Part B Supplier - Clinic/Group Practice (GA); Part B Supplier - Clinic/Group Practice (HI); Part B Supplier - Clinic/Group Practice (ID); Part B Supplier - Clinic/Group Practice (IL); Part B Supplier - Clinic/Group Practice (KS); Part B Supplier - Clinic/Group Practice (MA); Part B Supplier - Clinic/Group Practice (MD); Part B Supplier - Clinic/Group Practice (MI); Part B Supplier - Clinic/Group Practice (MS); Part B Supplier - Clinic/Group Practice (NV); Part B Supplier - Clinic/Group Practice (OH); Part B Supplier - Clinic/Group Practice (OR); Part B Supplier - Clinic/Group Practice (PA); Part B Supplier - Clinic/Group Practice (SC); Part B Supplier - Clinic/Group Practice (TX); Part B Supplier - Clinic/Group Practice (UT); Part B Supplier - Clinic/Group Practice (VA); Part B Supplier - Clinic/Group Practice (WA); Part B Supplier - Clinic/Group Practice (WI)

Enrollment (PECOS)

Enrolled Part B Supplier - Clinic/Group Practice (CA); Part B Supplier - Clinic/Group Practice (CO); Part B Supplier - Clinic/Group Practice (FL); Part B Supplier - Clinic/Group Practice (GA); Part B Supplier - Clinic/Group Practice (HI); Part B Supplier - Clinic/Group Practice (ID); Part B Supplier - Clinic/Group Practice (IL); Part B Supplier - Clinic/Group Practice (KS); Part B Supplier - Clinic/Group Practice (MA); Part B Supplier - Clinic/Group Practice (MD); Part B Supplier - Clinic/Group Practice (MI); Part B Supplier - Clinic/Group Practice (MS); Part B Supplier - Clinic/Group Practice (NV); Part B Supplier - Clinic/Group Practice (OH); Part B Supplier - Clinic/Group Practice (OR); Part B Supplier - Clinic/Group Practice (PA); Part B Supplier - Clinic/Group Practice (SC); Part B Supplier - Clinic/Group Practice (TX); Part B Supplier - Clinic/Group Practice (UT); Part B Supplier - Clinic/Group Practice (VA); Part B Supplier - Clinic/Group Practice (WA); Part B Supplier - Clinic/Group Practice (WI)

Medicare sources and data years

Other Radiology, Diagnostic Radiology providers in Bothell

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Bothell, WA · Individual
1871816694
Benjamin Ross Park, D.O.
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1770922676

All Radiology, Diagnostic Radiology providers in Washington →