NPIMap

Organization Active NPI

East Central Florida Outpatient Imaging LLC

  • Diagnostic Radiology Physician
  • Port Orange, FL
National Provider Identifier
1093757486
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
Practice address
1195 Dunlawton Ave
Port Orange, FL 32127-4745
Phone
(386) 763-5300
Fax
(386) 322-1616
NPI assigned
Jun 12, 2006
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 PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085B0100X FL
Neuroradiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0700X FL
Nuclear Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0904X FL
Pediatric Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085P0229X FL
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X FL Primary
Therapeutic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0203X FL
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X FL
Diagnostic Ultrasound PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085U0001X FL

Addresses

Primary practice location

1195 Dunlawton Ave
Port Orange, FL 32127-4745

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
V2885OtherFLBLUE CROSS

Other names 1

  • Port Orange 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
10D2238949Port Orange Imaging1195 Dunlawton Ave, Port Orange, FL 32127Certificate of waiverOct 6, 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.

Locations

2090 Saxon Blvd
Ste A
Deltona, FL 32725
Phone (386) 259-5959

3 Pine Cone Dr
Ste 101
Palm Coast, FL 32137
Phone (386) 446-5200

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1093757486",
    "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": "1195 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274745",
            "telephone_number": "386-763-5300",
            "fax_number": "386-322-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL FLORIDA OUTPATIENT IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V2885",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Orange Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orange, 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.