NPIMap

Organization Active NPI

Lake Medical Imaging and Breast Center at the Villages LLC

  • Diagnostic Radiology Physician
  • The Villages, FL
National Provider Identifier
1366015232
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC
Practice address
2955 Brownwood Blvd Ste 112
The Villages, FL 32163-2036
Phone
(352) 787-5858
Fax
(352) 787-4655
NPI assigned
Jul 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Joshua Lee Floyd, PHD
Title
Director, Risk Management
Phone
(365) 352-2583

Specialties & licenses 1

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

Addresses

Primary practice location

2955 Brownwood Blvd Ste 112
The Villages, FL 32163-2036

Mailing address

734 N 3Rd St Ste 115
Leesburg, FL 34748-5287
Phone (352) 787-5858

Other identifiers 1

IdentifierTypeStateIssuer
101183205MedicaidFL

Other names 1

  • Lake Medical Imaging AtThe Center For Advanced Healthcare at Brownwood Doing business as

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
10D2184757Lake Medical Imaging at the Center for2955 Brownwood Blvd Ste 112, The Villages, FL 32163Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lake Medical Imaging and Breast Center at the Villages LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1366015232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 N 3RD ST STE 115",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485287",
            "telephone_number": "352-787-5858",
            "fax_number": "352-728-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 BROWNWOOD BLVD STE 112",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321632036",
            "telephone_number": "352-787-5858",
            "fax_number": "352-787-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR, RISK MANAGEMENT",
        "authorized_official_telephone_number": "365-352-2583",
        "authorized_official_credential": "PHD"
    },
    "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": "101183205",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Medical Imaging AtThe Center For Advanced Healthcare at Brownwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Villages, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.