Central Georgia MRI LLC
Organization Active NPI Diagnostic Radiology Physician · Macon, GA
NPI 1114908522 · NPPES record last updated Nov 6, 2012
Key facts
- NPI
- 1114908522
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- CENTRAL GEORGIA MRI LLC
- Practice address
- 770 Pine St Ste L15
Attn: Radiology Department
Macon, GA 31201-7519 - Phone
- (478) 746-1020
- Fax
- (478) 746-0591
- NPI assigned
- Nov 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Mark E. Grossnickle, M.D.
- Title
- President
- Phone
- (478) 746-1020
Member of 1
Practitioners 78
-
Fayyaz Barodawala, M.D.
-
Hugo Falcon Jr., MD
-
Andrew R King, M.D.
-
Adam David Rogers, M.D.
-
Neal Simmons, MD
-
Algis Vincent Babusis, M.D.
-
Michael F Bloss, M.D.
-
Yulia Bronstein, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (26 enrollments) in GA, AZ, CA, NV, TX, CO, CT, MA, NH, VA, MO, MD, OH, SC, FL, AL, TN, DC, OR, IL, MS, GU, HI, PA, SD, NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427000147 | GA | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 36 practitioners Practice locations: Valdosta, GA; Savannah, GA; Peachtree City, GA; Columbus, GA; Marietta, GA; Macon, GA; Dunwoody, GA; Atlanta, GA… |
| O20191218002419 | AZ | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 3 practitioners Practice locations: Peoria, AZ; Tucson, AZ; Scottsdale, AZ |
| O20191231002056 | CA | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 3 practitioners Practice locations: Agoura Hills, CA; Irvine, CA; Rancho Palos Verdes, CA; San Diego, CA; San Francisco, CA |
| O20191231002191 | NV | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Las Vegas, NV; Reno, NV |
| O20200108001526 | TX | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 3 practitioners Practice locations: Dickinson, TX; North Richland Hills, TX; San Antonio, TX |
| O20200108002547 | CO | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Denver, CO; Fort Collins, CO |
| O20200113002301 | CT | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Canton, CT |
| O20200114000282 | MA | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Arlington, MA |
| O20200114001092 | NH | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Raymond, NH |
| O20200115002151 | VA | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 3 practitioners Practice locations: Ashburn, VA; Gainesville, VA; Virginia Beach, VA |
| O20200116001053 | MO | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint Louis, MO |
| O20200124001125 | MD | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Berlin, MD |
| O20200128002128 | OH | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Hudson, OH; Goshen, OH |
| O20200130002559 | SC | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Greenville, SC; Myrtle Beach, SC |
| O20200212001862 | FL | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 4 practitioners Practice locations: Green Cove Springs, FL; Hollywood, FL; Lakewood Ranch, FL; Palm City, FL; Sarasota, FL |
| O20200310001201 | AL | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Gadsden, AL |
| O20220201000509 | TN | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 3 practitioners Practice locations: Brentwood, TN; Signal Mountain, TN; Kingsport, TN |
| O20220315000258 | DC | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Reston, VA; Vienna, VA |
| O20220331002915 | OR | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Eugene, OR; Medford, OR |
| O20220428001547 | IL | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Oak Brook, IL |
| O20230321002110 | MS | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Madison, MS |
| O20230331000425 | GU | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Chalan Pago, GU |
| O20230915000457 | HI | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 2 practitioners Practice locations: Kailua, HI; Kapolei, HI |
| O20231003004024 | PA | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: New Kensington, PA |
| O20231128003114 | SD | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Spearfish, SD |
| O20240531000521 | NJ | Part B Supplier - Clinic/Group Practice | 5597752261 |
Receives reassigned benefits from 1 practitioner Practice locations: Denville, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
770 Pine St Ste L15
Attn: Radiology Department
Macon, GA 31201-7519
Mailing address
770 Pine St Ste L15
Attn: Radiology Department
Macon, GA 31201-7519
Phone (478) 746-1020
Other providers in Macon, GA
- Central Georgia Homecare Services, Inc
- Central Georgia Infectious Diseases Associates, LLC
- Central Georgia Internal Medicine, LLC
- Central Georgia Internist
- Central Georgia Kidney Specialists, PC
- Central Georgia Oral and Maxillofacial Surgery, LLC
- Central Georgia Pediatrics, Inc.
- Central Georgia Pediatrics, Inc.
- Central Georgia Pet LLC
- Central Georgia Pulmonary Associates, LLC
All providers in Macon, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.