NPIMap

Organization Active NPI

Clermont Radiology LLC

  • Radiology Clinic/Center
  • Clermont, FL
National Provider Identifier
1003328642
Registry record updated Nov 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
CLERMONT RADIOLOGY LLC
Practice address
3725 South Highway 27
Suite 104
Clermont, FL 34711
Phone
(352) 241-6100
Fax
(352) 241-6101
NPI assigned
Nov 3, 2017
Organization subpart
Yes
Parent organization
CLERMONT RADIOLOGY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert S. Kolb
Title
President/Ceo
Phone
(770) 833-1456

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

3725 South Highway 27
Suite 104
Clermont, FL 34711

Mailing address

PO Box 593869
Orlando, FL 32859-3869
Phone (352) 241-6100

Other names 1

  • Clermont Radiology-Kings Ridge Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190221000631 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9133156656 Practice locations: Clermont, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2158833Clermont Radiology - Kings Ridge3725 South Highway 27 Suite 104, Clermont, FL 34711Certificate of waiverDec 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
Clermont Radiology LLC2 organizations share this tax ID, including this one
Part of
Clermont Radiology LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3725 S Highway 27
Ste 104
Clermont, FL 34711
Phone (352) 241-6100

18 NE 1st Ave
Ocala, FL 34470
Phone (352) 241-6100

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 52

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509667200000",
    "number": "1003328642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 593869",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328593869",
            "telephone_number": "352-241-6100",
            "fax_number": "352-241-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 SOUTH HIGHWAY 27",
            "address_2": "SUITE 104",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "34711",
            "telephone_number": "352-241-6100",
            "fax_number": "352-241-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLERMONT RADIOLOGY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLERMONT RADIOLOGY LLC",
        "enumeration_date": "2017-11-03",
        "last_updated": "2017-11-03",
        "status": "A",
        "authorized_official_last_name": "KOLB",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "770-833-1456",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clermont Radiology-Kings Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.