NPIMap

Organization Active NPI

Second Avenue MRI LLC

  • Diagnostic Radiology Physician
  • Lake Charles, LA
National Provider Identifier
1629174339
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SECOND AVENUE MRI LLC
Practice address
2770 3Rd Ave
Suite 125
Lake Charles, LA 70601-8994
Phone
(337) 494-2674
Fax
(337) 494-2694
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

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

Authorized official

Name
Mr. Richard Martinez, M.D.NPI 1104809011
Title
President
Phone
(337) 494-2674

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2770 3Rd Ave
Suite 125
Lake Charles, LA 70601-8994

Mailing address

2770 3Rd Ave
Suite 125
Lake Charles, LA 70601-8994
Phone (337) 494-2674

Other identifiers 1

IdentifierTypeStateIssuer
1448001MedicaidLA

Other names 1

  • Advanced MRI Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, CA, TX3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20060105000738 LA Part B Supplier - Clinic/Group Practice 0749203610 Receives reassigned benefits from 18 practitioners
Practice locations: Lake Charles, LA
O20210524002732 CA Part B Supplier - Clinic/Group Practice 0749203610 Receives reassigned benefits from 1 practitioner
Practice locations: Palo Alto, CA
O20230302002374 TX Part B Supplier - Clinic/Group Practice 0749203610 Receives reassigned benefits from 1 practitioner
Practice locations: Katy, TX

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 135

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

View all 135

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392249600000",
    "number": "1629174339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE",
            "address_2": "SUITE 125",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018994",
            "telephone_number": "337-494-2674",
            "fax_number": "337-494-2694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 3RD AVE",
            "address_2": "SUITE 125",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018994",
            "telephone_number": "337-494-2674",
            "fax_number": "337-494-2694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND AVENUE MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2014-02-13",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-494-2674",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "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": "1448001",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; 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.