Boulevard Diagnostic Management Group, LLC

Primary specialty

Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X

Legal business name

BOULEVARD DIAGNOSTIC MANAGEMENT GROUP, LLC

Practice address

3120 W Southlake Blvd
Southlake, TX 76092-6783

Phone

(817) 741-0808

NPI assigned

Dec 19, 2012

Organization subpart

No

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

Authorized official

Name

Mr. James Aubrey Waller

Title

Managing Manager

Phone

(817) 528-7044

Specialties & licenses 1

Addresses

Tax ID family

Boulevard Diagnostic Management Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Boulevard Diagnostic MGMT Group

  • Radiology Clinic/Center
  • Southlake, TX
  • NPI 1922343342
  NPD tax ID

Practitioners 1

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

• Robert Lebaron Stears, MD

  • Diagnostic Radiology Physician
  • Fort Collins, CO
  • NPI 1457367864
  NPD (past)

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1194061135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 W SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926783",
            "telephone_number": "817-741-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 W SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926783",
            "telephone_number": "817-741-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD DIAGNOSTIC MANAGEMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "AUBREY",
        "authorized_official_title_or_position": "MANAGING MANAGER",
        "authorized_official_telephone_number": "817-528-7044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph A Bonola, DDS
• Amber Dawn Bontke, FNP
• Abriyannah Booker
• Kara (Rae) Rae Boswell, MS, RD, LD
• Kelli Bouck, BCBA
• Boulevard Diagnostic MGMT Group
• Elizabeth Marie Bourg, DPT
• Angela G Bowers, M.D.
• Erin Bowers, OTR/L
• Micah Christian Bowman, PA-C

• Magnetic Resonance Imaging (MRI) Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Magnetic Resonance Imaging (MRI) Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.