NPIMap

Organization Active NPI

Lake Regional Imaging Partners, LLC

  • Radiology Clinic/Center
  • Osage Beach, MO
National Provider Identifier
1245283290
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
LAKE REGIONAL IMAGING PARTNERS, LLC
Practice address
1075 Nichols Rd
Osage Beach, MO 65065-3093
Phone
(573) 348-6161
Fax
(573) 348-6162
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Authorized official

Name
Mr. David W. Halsell
Title
Sr. V.P., Cfo/Authorized Official
Phone
(573) 348-8388

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary
Mammography Clinic/Center 261QR0206X

Addresses

Primary practice location

1075 Nichols Rd
Osage Beach, MO 65065-3093

Mailing address

1075 Nichols Rd
Osage Beach, MO 65065-3093
Phone (573) 348-6161

Other identifiers 1

IdentifierTypeStateIssuer
710698002MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060307000583 MO Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2163439795 Practice locations: Osage Beach, MO

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1245283290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 NICHOLS RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653093",
            "telephone_number": "573-348-6161",
            "fax_number": "573-348-6162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 NICHOLS RD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653093",
            "telephone_number": "573-348-6161",
            "fax_number": "573-348-6162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGIONAL IMAGING PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "HALSELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "SR. V.P., CFO/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "573-348-8388",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710698002",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Osage Beach, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; 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.