Tellica Imaging, LLC
NPI 1144802802ActiveOrganization· Physiological Laboratory· Ogden, UT
Physiological Laboratory in Ogden, Utah, registered in NPPES in April 2021, part of Intermountain Healthcare. The authorized official on file is Brad Isaacson, PHD, President. Medicare paid $640,133 for services to 3,296 patients in 2024.
Overview
| NPI | 1144802802 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Intermountain Healthcare |
| NPI issued | Apr 22, 2021 |
| Last updated in NPPES | Mar 22, 2024 |
| Certified by provider | Mar 20, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physiological Laboratory Primary | 293D00000X | — | — |
| Clinic/Center, Radiology | 261QR0200X | — | — |
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 - Independent Diagnostic Testing Facility (Idtf) (UT) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 3,296 |
|---|---|
| Services billed | 4,486 across 60 procedure codes |
| Paid by Medicare | $640,133 |