Organization Active NPI

South Baldwin Diagnostic Imagine Associates, P.C.

  • Specialist
  • Foley, AL
National Provider Identifier
1124000856
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTH BALDWIN DIAGNOSTIC IMAGINE ASSOCIATES, P.C.
Practice address
1613 N McKenzie St
Foley, AL 36535-2247
Phone
(251) 949-1513
Fax
(251) 476-5460
NPI assigned
Nov 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Authorized official

Name
Mark R Connell, M.D.NPI 1730146069
Title
Authorized Official
Phone
(251) 949-3513

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1613 N McKenzie St
Foley, AL 36535-2247

Mailing address

PO Box 160550
Altamonte Springs, FL 32716-0550
Phone (713) 559-6929

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050121000219 AL Part B Supplier - Clinic/Group Practice 1254380769 Receives reassigned benefits from 5 practitioners
Practice locations: Foley, AL; Gulf Shores, AL; Robertsdale, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1124000856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160550",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327160550",
            "telephone_number": "713-559-6929",
            "fax_number": "713-559-6928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 N MCKENZIE ST",
            "city": "FOLEY",
            "state": "AL",
            "postal_code": "365352247",
            "telephone_number": "251-949-1513",
            "fax_number": "251-476-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BALDWIN DIAGNOSTIC IMAGINE ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "CONNELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "251-949-3513",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Foley, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; 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.