NPIMap

Organization Active NPI

Pdi Toledo, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Westlake, OH
National Provider Identifier
1497474084
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
PDI TOLEDO, LLC
Practice address
30400 Detroit Rd # 30
Westlake, OH 44145-1872
Phone
(440) 808-6736
Fax
(440) 808-0289
NPI assigned
Aug 25, 2022
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Jack Champney CornellNPI 1760298251
Title
Authorized Official
Phone
(440) 223-8848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU
Clinic/Center 261Q00000X NU
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X NU Primary

Addresses

Primary practice location

30400 Detroit Rd # 30
Westlake, OH 44145-1872

Mailing address

30400 Detroit Rd # 30
Westlake, OH 44145-1872
Phone (440) 808-6736

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230405002584 OH Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4284647181 Practice locations: Westlake, OH

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pdi Toledo LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1497474084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD # 30",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-808-6736",
            "fax_number": "440-808-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30400 DETROIT RD # 30",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451872",
            "telephone_number": "440-808-6736",
            "fax_number": "440-808-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDI TOLEDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-25",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "CHAMPNEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "440-223-8848"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.