NPIMap

Organization Active NPI

Mid-America Radiology Inc

  • Diagnostic Radiology Physician
  • Lexington, MO
National Provider Identifier
1073552972
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MID-AMERICA RADIOLOGY INC
Practice address
1500 State St
Lexington, MO 64067-1107
Phone
(660) 259-2203
Fax
(660) 259-6806
NPI assigned
Jun 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Authorized official

Name
Dr. Jay D Crockett, DO
Title
DO
Phone
(660) 259-2203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1500 State St
Lexington, MO 64067-1107

Mailing address

1500 State St
Lexington, MO 64067-1107
Phone (660) 259-2203

Other identifiers 2

IdentifierTypeStateIssuer
507573509MedicaidMO
DH1403OtherMORR MEDICARE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391126400000",
    "number": "1073552972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 STATE ST",
            "city": "LEXINGTON",
            "state": "MO",
            "postal_code": "640671107",
            "telephone_number": "660-259-2203",
            "fax_number": "660-259-6806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 STATE ST",
            "city": "LEXINGTON",
            "state": "MO",
            "postal_code": "640671107",
            "telephone_number": "660-259-2203",
            "fax_number": "660-259-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-AMERICA RADIOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2014-01-31",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "660-259-2203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507573509",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DH1403",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; 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.