NPIMap

Organization Active NPI

Pdi Toledo, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Middleburg Heights, OH
National Provider Identifier
1043936032
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
PDI TOLEDO, LLC
Practice address
19250 Bagley Rd Ste 202
Middleburg Heights, OH 44130-3348
Phone
(440) 260-9970
Fax
(440) 260-9980
NPI assigned
Oct 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Jack Champney Cornell
Title
Authorized Official
Phone
(440) 223-8848

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

19250 Bagley Rd Ste 202
Middleburg Heights, OH 44130-3348

Mailing address

19250 Bagley Rd Ste 202
Middleburg Heights, OH 44130-3348
Phone (440) 260-9970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240104003646 OH Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4284647181 Practice locations: Middleburg Heights, OH

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Pdi Toledo LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

20410 Observation Dr
Ste 106
Germantown, MD 20876
Phone (240) 397-6674

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1043936032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19250 BAGLEY RD STE 202",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441303348",
            "telephone_number": "440-260-9970",
            "fax_number": "440-260-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19250 BAGLEY RD STE 202",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441303348",
            "telephone_number": "440-260-9970",
            "fax_number": "440-260-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDI TOLEDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "CHAMPNEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "440-223-8848"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.