NPIMap

Organization Active NPI

Bca Georgia, LLC

Doing business as Lakeside Imaging

  • Radiology Clinic/Center
  • Milledgeville, GA
National Provider Identifier
1679294227
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
BCA GEORGIA, LLC
Doing business as
Lakeside Imaging
Practice address
1850 N Columbia St Ste 3
Milledgeville, GA 31061-7113
Phone
(478) 453-4101
NPI assigned
Sep 12, 2022
Last updated
Feb 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

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

Authorized official

Name
Dr. Gary Harper Dent, MDNPI 1841255759
Title
Ceo
Phone
(912) 764-2455

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
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1850 N Columbia St Ste 3
Milledgeville, GA 31061-7113

Mailing address

PO Box 1067
Statesboro, GA 30459-1067
Phone (912) 764-2455

Other names 1

  • Lakeside Imaging Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230320001720 GA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3072987742 Practice locations: Milledgeville, GA

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
11D2038013Lakeside Imaging1850 North Columbia Street, Suite 3, Milledgeville, GA 31061Certificate of waiverMar 11, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1850 N Columbia St
Ste 3
Milledgeville, GA 31061
Phone (478) 453-4101

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1679294227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1067",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304591067",
            "telephone_number": "912-764-2455",
            "fax_number": "912-764-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N COLUMBIA ST STE 3",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310617113",
            "telephone_number": "478-453-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BCA GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-12",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "DENT",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "HARPER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-764-2455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milledgeville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.