OrganizationActive
Provena Imaging Services Inc
NPI 1720197601 · Diagnostic Radiology Physician · Bourbonnais, IL
Provider details
- NPI number
- 1720197601
- Entity type
- Organization
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Edward Molare, President(815) 806-2309
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
100 Provena Way
Suite 104
Bourbonnais, IL 60914
Phone: (815) 929-5800
Fax: (815) 929-5801
Street-level locationGet directions
Mailing address
5775 Wayzata Blvd
St Louis Park, MN 55416
Other names (DBA / former)
- Doing business as
- Provena Health Center for Diagnostic Imaging
Registry dates
- Enumerated
- 2006-08-30
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.