Eagle Imaging Management Group, LLC – Diagnostic Radiology Physician, NPI 1548450976
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Eagle Imaging Management Group, LLC
3110 SW 89th St
Oklahoma City, OK 731597920
Phone: (405) 602-8100
Type: Location
9800 Broadway Ext
Oklahoma City, OK 731146303
Phone: (405) 419-2980
Type: Location
3600, Northwest 138th Street, Oklahoma City, Oklahoma County, Oklahoma, 73134, United States
SUITE 102
OKLAHOMA CITY, OK 731342503
Phone: (405) 286-4114
Fax: (405) 463-0154
Type: Location
8100 S Walker Ave Bldg C
Oklahoma City, OK 731399404
Phone: (405) 602-6500
Type: Location
3600 NW 138th St
Suite 102
Oklahoma City, OK 731342503
Phone: (405) 286-4114
Fax: (405) 463-0154
Type: Location
US Hwy 81 & US Hwy 70
Waurika, OK 73573
Phone: (580) 228-2344
Type: Location
1414 Duncan Regional Loop
Duncan, OK 735331595
Phone: (580) 251-6670
Type: Location
2220 W Iowa Ave
Chickasha, OK 730182700
Phone: (405) 224-2300
Type: Location
5602 SW Lee Blvd
Lawton, OK 735059699
Phone: (580) 531-4812
Type: Location
300 S Rockwell Ave
Oklahoma City, OK 731282222
Phone: (405) 500-3430
Type: Location
4801 SE 15th St
Del City, OK 731153918
Phone: (405) 500-3380
Type: Location
5116 W Gore Blvd
Lawton, OK 735055909
Phone: (580) 353-7226
Type: Location
230 SW 80th St
Oklahoma City, OK 731398107
Phone: (405) 634-8405
Type: Location
13301 N Meridian Ave Ste 600A
Oklahoma City, OK 731209369
Phone: (405) 752-1994
Type: Location
14101 Parkway Commons Dr
Oklahoma City, OK 731346012
Phone: (405) 749-2700
Type: Location
9901 S Pennsylvania Ave
Oklahoma City, OK 731596920
Phone: (405) 691-8558
Type: Location
3100 SW 89th St
Oklahoma City, OK 731597900
Phone: (405) 605-2660
Type: Location
1401 SW 34th St
Moore, OK 731603059
Phone: (405) 500-3330
Type: Location
9417 N Council Rd
Oklahoma City, OK 731626228
Phone: (405) 500-3280
Type: Location
10914 Hefner Pointe Dr Ste 100
Oklahoma City, OK 731205073
Phone: (405) 488-7226
Type: Location
9204 N May Ave
Oklahoma City, OK 731204419
Phone: (405) 848-1918
Type: Location
PO BOX 205193
DALLAS, TX 753205193
Phone: (405) 334-5226
Type: Mailing
2621 N WHISENANT DR
DUNCAN, OK 73533
Phone: (580) 252-5300
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-12-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1045 days ago).
Enrollment records
32
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20071011000078 | O | Clinic/Group Practice | OK | 2026-03-31 |
| O20121031000252 | O | Clinic/Group Practice | TX | TBD |
| O20140317001788 | O | Clinic/Group Practice | CA | 2025-06-30 |
| O20140408001277 | O | Clinic/Group Practice | FL | 2024-08-31 |
| O20140514001133 | O | Clinic/Group Practice | NE | 2025-07-31 |
| O20140819001131 | O | Clinic/Group Practice | CO | TBD |
| O20141002000836 | O | Clinic/Group Practice | PA | TBD |
| O20170227001195 | O | Clinic/Group Practice | MO | TBD |
| O20170530001346 | O | Clinic/Group Practice | IL | 2023-07-31 |
| O20170921001749 | O | Clinic/Group Practice | GA | 2023-09-30 |
| O20171026003386 | O | Clinic/Group Practice | MT | 2025-10-31 |
| O20180406000153 | O | Clinic/Group Practice | HI | 2024-06-30 |
| O20180409001959 | O | Clinic/Group Practice | NC | 2024-07-31 |
| O20180418000628 | O | Clinic/Group Practice | OH | TBD |
| O20180802002137 | O | Clinic/Group Practice | AZ | 2024-10-31 |
| O20190416000796 | O | Clinic/Group Practice | AL | 2025-11-30 |
| O20191202000053 | O | Clinic/Group Practice | DC | 2025-12-31 |
| O20191223000533 | O | Clinic/Group Practice | MI | 2026-01-31 |
| O20210114000481 | O | Clinic/Group Practice | TN | 2026-02-28 |
| O20210426001940 | O | Clinic/Group Practice | LA | 2026-04-30 |
| O20211011002602 | O | Clinic/Group Practice | OR | TBD |
| O20220304001034 | O | Clinic/Group Practice | WY | TBD |
| O20220805001260 | O | Clinic/Group Practice | VA | TBD |
| O20221006002503 | O | Clinic/Group Practice | NV | TBD |
| O20230111000035 | O | Clinic/Group Practice | WA | TBD |
| O20230224000615 | O | Clinic/Group Practice | SC | TBD |
| O20231104000212 | O | Clinic/Group Practice | NY | TBD |
| O20240212000828 | O | Clinic/Group Practice | ME | TBD |
| O20240324000068 | O | Clinic/Group Practice | UT | TBD |
| O20241104003075 | O | Clinic/Group Practice | WI | TBD |
| O20250905003089 | O | Clinic/Group Practice | KY | TBD |
| O20251201001933 | O | Clinic/Group Practice | NM | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 73159)
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