NPIMap

Organization Active NPI

Lake Medical Imaging and Breast Center at the Villages LLC

Doing business as Lake Medical Imaging at Mulberry Grove

  • Diagnostic Radiology Physician
  • The Villages, FL
National Provider Identifier
1659940807
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC
Doing business as
Lake Medical Imaging at Mulberry Grove
Practice address
8801 SE 165TH Mulberry LN
The Villages, FL 32162-5887
Phone
(352) 787-5858
Fax
(352) 787-4655
NPI assigned
Jun 22, 2021
Last updated
Jun 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Authorized official

Name
Joshua Lee Floyd, PHD
Title
Director, Risk Management
Phone
(365) 352-2583

Specialties & licenses 1

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

Addresses

Primary practice location

8801 SE 165TH Mulberry LN
The Villages, FL 32162-5887

Mailing address

734 N 3Rd St Ste 115
Leesburg, FL 34748-5287
Phone (352) 787-5858

Other identifiers 1

IdentifierTypeStateIssuer
101183203MedicaidFL

Other names 1

  • Lake Medical Imaging at Mulberry Grove Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2078655Lake Medical Imaging at Mulberry Grove8801 SE 165TH Mulberry LN, The Villages, FL 32162Certificate of waiverJun 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lake Medical Imaging and Breast Center at the Villages LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

734 N 3rd St
Ste 115
Leesburg, FL 34748
Phone (352) 365-2583

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1659940807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "734 N 3RD ST STE 115",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485287",
            "telephone_number": "352-787-5858",
            "fax_number": "352-728-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8801 SE 165TH MULBERRY LN",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321625887",
            "telephone_number": "352-787-5858",
            "fax_number": "352-787-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR, RISK MANAGEMENT",
        "authorized_official_telephone_number": "365-352-2583",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101183203",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Medical Imaging at Mulberry Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in The Villages, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.