NPIMap

Individual provider Active NPI

Maxwell Lazinger, M.D.

  • Vascular & Interventional Radiology Physician
  • Columbia, MO
National Provider Identifier
1306833405
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
2002007687 Issued in MO
Practice address
1600 E Broadway
Columbia, MO 65201-5844
Phone
(573) 815-3221
Fax
(573) 815-6343
NPI assigned
Oct 4, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2002007687 MO
Vascular & Interventional Radiology Physician 2085R0204X 2002007687 MO Primary

Addresses

Primary practice location

1600 E Broadway
Columbia, MO 65201-5844

Mailing address

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-3221

Other identifiers 1

IdentifierTypeStateIssuer
205811201MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051219000476 MO Practitioner - Diagnostic Radiology 5193746188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Practice addresses (Care Compare)

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2002007687MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Landmark Hospital of Columbia LLC CurrentSince Nov 16, 2023 Accepting new patients
Boone Physician Services, LLC CurrentSince Nov 16, 2023 Accepting new patients
American Radiology Associates, P.a. Diagnostic Radiology Past Accepting new patients
Mid-America Anesthesia Consultants, PC Past Accepting new patients

Locations

604 Old Highway 63 N
Columbia, MO 65201
Phone (573) 499-6600

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

3255 Independence St
Cpe Girardeau, MO 63701
Phone (573) 331-8026

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1306833405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-3221",
            "fax_number": "573-815-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-3221",
            "fax_number": "573-815-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZINGER",
        "first_name": "MAXWELL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2002007687",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MO",
            "license": "2002007687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205811201",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.