NPIMap

Organization Active NPI

East Central Florida Outpatient Imaging LLC

Doing business as Twin Lakes Imaging Center

  • Diagnostic Radiology Physician
  • Daytona Beach, FL
National Provider Identifier
1023040870
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC
Doing business as
Twin Lakes Imaging Center
Practice address
1890 Lpga Blvd
Suite 110
Daytona Beach, FL 32117-7130
Phone
(386) 274-7272
Fax
(386) 274-5440
NPI assigned
Jul 6, 2006
Last updated
Feb 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Authorized official

Name
Mr. Al Falco
Title
Ceo
Phone
(386) 274-7118

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X NU
Neuroradiology Physician 2085N0700X NU
Nuclear Radiology Physician 2085N0904X NU
Pediatric Radiology Physician 2085P0229X NU
Diagnostic Radiology Physician 2085R0202X NU Primary
Therapeutic Radiology Physician 2085R0203X NU
Vascular & Interventional Radiology Physician 2085R0204X NU
Diagnostic Ultrasound Physician 2085U0001X NU

Addresses

Primary practice location

1890 Lpga Blvd
Suite 110
Daytona Beach, FL 32117-7130

Mailing address

1673 Mason Ave
Suite 305
Daytona Beach, FL 32117-5515
Phone (386) 274-7118

Other identifiers 1

IdentifierTypeStateIssuer
V2860OtherFLBLUE CROSS

Other names 1

  • Twin Lakes Imaging Center Doing business as

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
10D2209131East Centeral Florida Outpatient Imaging1890 Lpga Blvd, Daytona Beach, FL 32117Certificate of waiverJan 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Central Florida Outpatient Imaging LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1023040870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE",
            "address_2": "SUITE 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175515",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 LPGA BLVD",
            "address_2": "SUITE 110",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177130",
            "telephone_number": "386-274-7272",
            "fax_number": "386-274-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "FALCO",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-274-7118",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V2860",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin Lakes Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.