Jacksonville Beaches Medical Imaging Inc

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

HCCR1418 Issued in FL

Legal business name

JACKSONVILLE BEACHES MEDICAL IMAGING INC

Doing business as

Southside Medical Imaging

Practice address

6138 Kennerly Rd
Suite 101
Jacksonville, FL 32216-4345

Phone

(904) 733-7770

Fax

(904) 733-7778

NPI assigned

Sep 30, 2005

Last updated

Oct 2, 2012By 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

Mrs. Cathy Blaese

Title

Chief Operating Officer

Phone

(904) 241-7772

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• SOUTHSIDE MEDICAL IMAGING Doing business as

Practitioners 1

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.

• Carlos A Rivera, M.D.

  • Diagnostic Radiology Physician
  • Savannah, GA
  • NPI 1942294848
  NPD (past)

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1568459055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6138 KENNERLY RD",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164345",
            "telephone_number": "904-733-7770",
            "fax_number": "904-733-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6138 KENNERLY RD",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164345",
            "telephone_number": "904-733-7770",
            "fax_number": "904-733-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE BEACHES MEDICAL IMAGING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "BLAESE",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "904-241-7772",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCCR1418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS VIN #",
            "identifier": "V2499",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1ST HEALTH PROVIDER",
            "identifier": "1840590",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2052827",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "470001168",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1ST HEALTH W/C #",
            "identifier": "147878601",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "7842141",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHSIDE MEDICAL IMAGING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Radiology Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.