NPIMap

Organization Active NPI

Radiology Regional Center, PA

  • Diagnostic Radiology Physician
  • Lehigh Acres, FL
National Provider Identifier
1295401016
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY REGIONAL CENTER, PA
Practice address
5220 Lee Blvd
Lehigh Acres, FL 33971-1036
Phone
(239) 369-8950
Fax
(239) 369-8760
NPI assigned
Aug 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Brian A Krivisky, MD
Title
Ceo
Phone
(239) 936-2316

Specialties & licenses 1

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

Addresses

Primary practice location

5220 Lee Blvd
Lehigh Acres, FL 33971-1036

Mailing address

3660 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316

Other identifiers 1

IdentifierTypeStateIssuer
054636420MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Radiology Regional Center PA13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1295401016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 BROADWAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018005",
            "telephone_number": "239-936-2316",
            "fax_number": "239-834-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 LEE BLVD",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339711036",
            "telephone_number": "239-369-8950",
            "fax_number": "239-369-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY REGIONAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "KRIVISKY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-936-2316",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054636420",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; 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.