Organization Active NPI

Metrolina Neurodiagnostic Center, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Rock Hill, SC
National Provider Identifier
1265425524
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
METROLINA NEURODIAGNOSTIC CENTER, LLC
Practice address
127 Professional Park Blvd
Rock Hill, SC 29732-1178
Phone
(803) 329-8635
Fax
(803) 329-8645
NPI assigned
Aug 23, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Howard Mandell, M.D.NPI 1316939697
Title
Partner
Phone
(803) 366-6135

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
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

127 Professional Park Blvd
Rock Hill, SC 29732-1178

Mailing address

127 Professional Park Blvd
Rock Hill, SC 29732-1178
Phone (803) 329-8635

Other identifiers 2

IdentifierTypeStateIssuer
GP3790MedicaidSC
89015KFMedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000323 SC Part B Supplier - Clinic/Group Practice 0547163115 Receives reassigned benefits from 1 practitioner
Practice locations: Rock Hill, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1105534Metrolina Neurodiagnostic Ctr LLC127 Professional Park Dr, Rock Hill, SC 29732Certificate of waiverSep 23, 2027

National Provider Directory

National Provider Directory

Locations

127 Professional Park Dr
Rock Hill, SC 29732
Phone (803) 329-8635

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265425524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PROFESSIONAL PARK BLVD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321178",
            "telephone_number": "803-329-8635",
            "fax_number": "803-329-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 PROFESSIONAL PARK BLVD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321178",
            "telephone_number": "803-329-8635",
            "fax_number": "803-329-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROLINA NEURODIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANDELL",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "803-366-6135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3790",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015KF",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.