NPIMap

Organization Active NPI

Florida Radiology Imaging at Lake Mary, LLC

Doing business as AdventHealth Imaging Center Clermont

  • Diagnostic Radiology Physician
  • Clermont, FL
National Provider Identifier
1386316602
Registry record updated Nov 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC
Doing business as
AdventHealth Imaging Center Clermont
Practice address
1919 E Highway 50 Ste 101
Clermont, FL 34711-1975
Phone
(352) 717-3738
Fax
(352) 717-3739
NPI assigned
Oct 5, 2021
Last updated
Nov 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2021

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

Authorized official

Name
Michael Mazeres
Title
Vice President
Phone
(407) 357-1912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1919 E Highway 50 Ste 101
Clermont, FL 34711-1975

Mailing address

235 E Princeton St Ste 100
Orlando, FL 32804-5554
Phone (407) 303-1414

Other names 1

  • AdventHealth Imaging Center Clermont Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Adventhealth Imaging12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1386316602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E PRINCETON ST STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328045554",
            "telephone_number": "407-303-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E HIGHWAY 50 STE 101",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111975",
            "telephone_number": "352-717-3738",
            "fax_number": "352-717-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "MAZERES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "407-357-1912"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Imaging Center Clermont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.