Florida Diagnostic Imaging Center

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

FLORIDA DIAGNOSTIC IMAGING CENTER

Doing business as

Blue Water Diagnostic Imaging

Practice address

4536 E Highway 20
Niceville, FL 32578-9755

Phone

(850) 729-6747

Fax

(850) 729-7279

NPI assigned

May 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Daniel J Schaefer

Title

Coo

Phone

(770) 300-0101

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Blue Water Diagnostic Imaging Doing business as

Locations

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1043278831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 PRESTON RIDGE RD STE 600",
            "address_2": "CREDENTIALING DEPT",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300055462",
            "telephone_number": "770-300-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4536 E HIGHWAY 20",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325789755",
            "telephone_number": "850-729-6747",
            "fax_number": "850-729-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DIAGNOSTIC IMAGING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-300-0101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262856200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISTA SUNRISE",
            "identifier": "SG076082",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2403386",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7228598",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "V2732",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "470000878",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Diagnostic Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• FL-I Medical Services LLC
• Flagstone Peak Emergency Physicians LLC
• Flat Top Inpatient Services LLC
• Shantie Fletcher, LMT
• Alisha L Florence, PA
• Florida Em-I Medical Services, PA
• Florida Urgent & Family Care P a
• FNP & Associates, PLLC (EasyCare Walk-in Clinic)
• Jay Foil
• Yazdel Fonseca-Dodd

• Diagnostic Radiology Physician in Niceville, FL
• Providers in Niceville, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.