Donald Kolman Imwalle, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

35084579 Issued in OH

Practice address

3000 Mack Rd
Fairfield, OH 45014-5335

Phone

(513) 965-8041

Fax

(513) 965-8091

NPI assigned

Jun 5, 2006

Last updated

Jan 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH, CA, FL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Diagnostic Radiology

Education

University of Cincinnati College of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleveland Clinic FloridaGroup PAC ID 7911807128, 717 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Indian River Hospital Hospital, Vero Beach, FL, CCN 100105
• Cleveland Clinic Martin North Hospital Hospital, Stuart, FL, CCN 100044

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cleveland Clinic Florida a Nonprofit Corporation

  • Clinic/Center
  • Weston, FL
  • NPI 1215989298
  Medicare reassignment Care Compare group NPD
• Regents of the University of California

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1558463927
  Medicare reassignment NPD
• Columbus Radiology Corp

  • Diagnostic Radiology Physician
  • Columbus, OH
  • NPI 1669408159
  Medicare reassignment
• Physiatric Associates Inc

  • Specialist
  • Burlington, KY
  • NPI 1205837226
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indian River Memorial Hospital Inc

  dba Cleveland Clinic Indian River Hospital

  • General Acute Care Hospital
  • Vero Beach, FL
  • NPI 1376512988
  Care Compare affiliation
• Martin Memorial Medical Center Inc

  dba Cleveland Clinic Martin North, South, Tradition Hospitals

  • General Acute Care Hospital
  • Stuart, FL
  • NPI 1194790055
  Care Compare affiliation

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1164461372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 N ELM ST",
            "address_2": "SUITE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274016302",
            "telephone_number": "336-274-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 MACK RD",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450145335",
            "telephone_number": "513-965-8041",
            "fax_number": "513-965-8091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMWALLE",
        "first_name": "DONALD",
        "middle_name": "KOLMAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35084579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008517420A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2738041",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McKinley David Hunter
• Courtney Nicole Hutsell
• Harriet Ijoni
• Blaise Ileleke Bomandeke
• Ayisha Ilias, FNP-C
• Mark David Imwalle, MD
• In Catherines Care LLC
• Independent Community Services
• Jennifer Ingle, DMD
• Integrated Pain Solutions Incorporated

• Diagnostic Radiology Physician in Fairfield, OH
• Providers in Fairfield, OH by specialty
• Diagnostic Radiology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.