NPIMap

Organization Active NPI

Radiology & Imaging Specialists of Lakeland, PA

  • Diagnostic Radiology Physician
  • Lakeland, FL
National Provider Identifier
1235401480
Registry record updated Nov 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Practice address
3021 Lakeland Highlands Rd
Ste 3
Lakeland, FL 33803-4339
Phone
(863) 688-2334
Fax
(863) 577-1167
NPI assigned
Feb 3, 2012
Organization subpart
Yes
Parent organization
RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2016

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

Authorized official

Name
Edward J Goodemote, PHD, RN
Title
Ceo
Phone
(863) 577-0303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

3021 Lakeland Highlands Rd
Ste 3
Lakeland, FL 33803-4339

Mailing address

2125 Crystal Grove Dr
Lakeland, FL 33801-6875
Phone (866) 804-7649

Other identifiers 1

IdentifierTypeStateIssuer
V0068OtherFLBCBS FL

Other names 1

  • SOUTHSIDE OFFICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090306000484 FL Part B Supplier - Clinic/Group Practice 2264422294 Receives reassigned benefits from 88 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Radiology Imaging Spec38 organizations share this tax ID, including this one
Part of
Radiology Imaging Spec

Other organizations with this tax ID 37

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

View all 37

Locations

3021 Lakeland Highlands Rd
Ste 3
Lakeland, FL 33803

2125 Crystal Grove Dr
Lakeland, FL 33801
Phone (863) 701-2225

Practitioners & affiliated clinicians

Practitioners 4

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": "1328227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478131200000",
    "number": "1235401480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 CRYSTAL GROVE DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338016875",
            "telephone_number": "866-804-7649",
            "fax_number": "614-764-9147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 LAKELAND HIGHLANDS RD",
            "address_2": "STE 3",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338034339",
            "telephone_number": "863-688-2334",
            "fax_number": "863-577-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA",
        "enumeration_date": "2012-02-03",
        "last_updated": "2016-11-03",
        "status": "A",
        "authorized_official_last_name": "GOODEMOTE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-577-0303",
        "authorized_official_credential": "PHD, RN"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "V0068",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHSIDE OFFICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; 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.