NPIMap

Organization Active NPI

Simonmed Imaging Florida LLC

Doing business as Simonmed Imaging Waterford Lakes

  • Diagnostic Radiology Physician
  • Orlando, FL
National Provider Identifier
1619547601
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SIMONMED IMAGING FLORIDA LLC
Doing business as
Simonmed Imaging Waterford Lakes
Practice address
775 N Alafaya TRL
Orlando, FL 32828-7047
Phone
(321) 235-8700
NPI assigned
Jun 30, 2021
Last updated
Feb 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Authorized official

Name
Howard John Simon, MDNPI 1073583068
Title
Ceo/Owner
Phone
(602) 809-6623

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

775 N Alafaya TRL
Orlando, FL 32828-7047

Mailing address

6900 E Camelback Rd Ste 700
Scottsdale, AZ 85251-2400
Phone (480) 306-6949

Other names 1

  • SIMONMED IMAGING WATERFORD LAKES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120320000846 FL Part B Supplier - Clinic/Group Practice 6608036108 Receives reassigned benefits from 168 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 38

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 38

National Provider Directory

National Provider Directory
Tax ID family
Simonmed Imaging Florida LLC32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Locations

6900 E Camelback Rd
Ste 700
Scottsdale, AZ 85251
Phone (602) 651-1945

Practitioners & affiliated clinicians

Practitioners 6

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": "1625011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1619547601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 E CAMELBACK RD STE 700",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852512400",
            "telephone_number": "480-306-6949",
            "fax_number": "602-302-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 N ALAFAYA TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328287047",
            "telephone_number": "321-235-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMONMED IMAGING FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-30",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "602-809-6623",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIMONMED IMAGING WATERFORD LAKES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SIMONMED IMAGING WATERFORD LAKES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.