Radiology & Imaging Specialists of Lakeland, PA
Organization Active NPI Diagnostic Radiology Physician · Lakeland, FL
NPI 1649543992 · NPPES record last updated Mar 3, 2026
Key facts
- NPI
- 1649543992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
- Practice address
- 1305 Lakeland Hills Blvd
Lakeland, FL 33805-4542 - Phone
- (863) 688-2334
- Fax
- (706) 653-1230
- NPI assigned
- Feb 17, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- RADIOLOGY & IMAGING SPECIALISTS OF LAKELAND, PA
Authorized official
- Name
- John Barrett
- Title
- Cfo
- Phone
- (863) 688-2334
Other NPIs on the same Medicare enrollment 6
Member of 2
Practitioners 3
-
Elena Motuzko, MD
-
Charles Kenneth Requard, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2167348 | Radiology and Imaging Specialists of Lakeland PA | Certificate of waiver | Jun 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090306000484 | FL | Part B Supplier - Clinic/Group Practice | 2264422294 |
Receives reassigned benefits from 88 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Radiology Imaging Spec
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
1305 Lakeland Hills Blvd
Lakeland, FL 33805-4542
Mailing address
PO Box 20027
Tampa, FL 33622-0027
Phone (800) 475-6112
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V2699 | Other | FL | BCBS FL |
Other names
- CENTRAL IMAGING CENTER
Other providers in Lakeland, FL
- Radiology & Imaging Specialists of Lakeland PA
- Radiology & Imaging Specialists of Lakeland, PA
- Radiology & Imaging Specialists of Lakeland, PA
- Radiology & Imaging Specialists of Lakeland, PA
- Radiology & Imaging Specialists of Lakeland, PA
- Radiology & Imaging Specialists of Lakeland, PA
- Radiology & Imaging Specialists of Lakeland, PA
- Mikhail Radivilov
- Martin Geza Radvany
- Sarah Ann Rager
All providers in Lakeland, FL · Diagnostic Radiology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.