Columbus Regional Diagnostics

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

COLUMBUS REGIONAL DIAGNOSTICS

Doing business as

Advanced Imaging

Practice address

509 Olde Waterfordway
Suite 104
Leland, NC 28451

Phone

(910) 640-4380

Fax

(910) 399-4353

NPI assigned

Nov 29, 2021

Last updated

Jan 27, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

COLUMBUS REGIONAL DIAGNOSTICSAs reported in NPPES

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

Authorized official

Name

Kimberly Jeffery Gore

Title

Chief Financial Officer

Phone

(191) 064-0406

Specialties & licenses 1

Addresses

Other names 2

• ADVANCED IMAGING Doing business as
• Columbus Regional Diagnostics Former legal business name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Columbus Regional Diagnostics

  dba Advanced Imaging

  • Physiological Laboratory
  • Whiteville, NC
  • NPI 1417298134

  5092941971

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Columbus Regional Diagnostics2 organizations share this tax ID, including this one

Part of

Columbus Regional Diagnostics

Other organizations with this tax ID 1

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

• Columbus Regional Diagnostics

  dba Advanced Imaging

  • Physiological Laboratory
  • Whiteville, NC
  • NPI 1417298134
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Columbus Regional Diagnostics

  dba Advanced Imaging

  • Physiological Laboratory
  • Whiteville, NC
  • NPI 1417298134
  NPPES parent name

Practitioners 1

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.

• Jeffrey M Kotzan, M.D.

  • Diagnostic Radiology Physician
  • Fayetteville, NC
  • NPI 1730184904
  NPD

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1114684941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723634",
            "telephone_number": "910-640-4060",
            "fax_number": "910-642-9328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORDWAY",
            "address_2": "SUITE 104",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "28451",
            "telephone_number": "910-640-4380",
            "fax_number": "910-399-4353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "619 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Whiteville",
            "state": "NC",
            "postal_code": "284723707",
            "country_code": "US",
            "telephone_number": "910-642-9085",
            "fax_number": "910-642-3082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLUMBUS REGIONAL DIAGNOSTICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBUS REGIONAL DIAGNOSTICS",
        "enumeration_date": "2021-11-29",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "JEFFERY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "191-064-0406"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED IMAGING",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Columbus Regional Diagnostics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jajuan Cofield
• Christopher Colella
• Jean Mary Coles, LPC; LCMHC
• Kinley Collins
• Stephanie Lynn Collins, PA-C
• Stefani Meagan Connel, MD
• Kathleen Anna Considine
• Mary-Lou Elizabeth Cook, OTR/L
• Linda Joyce Cooper, LCSW
• Core Therapy Services, Inc. (Core Physical Therapy)

• Physiological Laboratory in Leland, NC
• Providers in Leland, NC by specialty
• Physiological Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.