NPIMap

Organization Active NPI

Pdi Toledo, LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Medina, OH
National Provider Identifier
1699494286
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
PDI TOLEDO, LLC
Practice address
3443 Medina Rd Ste 103
Medina, OH 44256-5965
Phone
(330) 723-6600
Fax
(330) 725-6671
NPI assigned
Aug 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Jack Champney Cornell
Title
Authorized Official
Phone
(440) 223-8848

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X
Clinic/Center 261Q00000X
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary

Addresses

Primary practice location

3443 Medina Rd Ste 103
Medina, OH 44256-5965

Mailing address

3443 Medina Rd Ste 103
Medina, OH 44256-5965
Phone (330) 723-6600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221227000889 OH Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4284647181 Practice locations: Medina, OH

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pdi Toledo LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

Dept AT 952561
Atlanta, GA 31192

3443 Medina Rd
Ste 103
Medina, OH 44256
Phone (330) 723-6600

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1699494286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3443 MEDINA RD STE 103",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565965",
            "telephone_number": "330-723-6600",
            "fax_number": "330-725-6671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3443 MEDINA RD STE 103",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565965",
            "telephone_number": "330-723-6600",
            "fax_number": "330-725-6671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDI TOLEDO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-25",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "CHAMPNEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "440-223-8848"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; 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.