Florida Diagnostic Imaging Center

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

FLORIDA DIAGNOSTIC IMAGING CENTER

Doing business as

Open MRI of Fort Walton

Practice address

908 Mar Walt Dr
Fort Walton Beach, FL 32547-6706

Phone

(850) 862-9394

Fax

(850) 862-8533

NPI assigned

May 2, 2006

Last updated

Sep 23, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Daniel J Schaefer

Title

Coo

Phone

(770) 300-0101

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Open MRI of Fort Walton Doing business as

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1356309074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933544",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311933544",
            "telephone_number": "770-300-0101",
            "fax_number": "770-300-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-862-9394",
            "fax_number": "850-862-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DIAGNOSTIC IMAGING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-300-0101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2403398",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262856200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "470000877",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISTA SUNRISE",
            "identifier": "SG076079",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7168661",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ALABAMA",
            "identifier": "55303",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "V2705",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open MRI of Fort Walton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florida Department of Health (Okaloosa County Health Dept-School Health)
• Florida Department of Health (Okaloosa County Health Dept-STD)
• Florida Department of Health (Okaloosa County Health Dept-OB)
• Florida Department of Health (Okaloosa County Health Dept-Phys Care)
• Florida Department of Health (Okaloosa County Health Dept-Family Planning)
• Florida Diagnostic Imaging Center (Florida Diagnostic Imaging Mobile MRI Unit)
• Florida Em-I Medical Services, P.a.
• Florida Medical Laboratory Group, Inc
• Florida Mentor II LLC (Fort Walton Beach Developmental Center)
• Florida Trauma Services, LLC

• Diagnostic Radiology Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.