NPIMap

Organization Active NPI

Bay Radiology Womens Imaging Center, LLC

  • Diagnostic Radiology Physician
  • Panama City, FL
National Provider Identifier
1720238769
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
BAY RADIOLOGY WOMENS IMAGING CENTER, LLC
Practice address
330 W. 23Rd St.
Panama City, FL 32405-7614
Phone
(850) 763-2451
Fax
(850) 747-4908
NPI assigned
Sep 26, 2008
Last updated
Aug 18, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
BAY RADIOLOGY ASSOCIATES, PLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Authorized official

Name
Dr. Lloyd G. Logue, D.O.NPI 1992776066
Title
Ceo
Phone
(850) 763-2451

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 Physician 2085R0202X Primary

Addresses

Primary practice location

330 W. 23Rd St.
Panama City, FL 32405-7614

Mailing address

PO Box 1770
Panama City, FL 32402-1770
Phone (850) 747-4905

Other identifiers 2

IdentifierTypeStateIssuer
V2983OtherFLBCBS
000969700MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081215000622 FL Part B Supplier - Clinic/Group Practice 3375605033 Receives reassigned benefits from 3 practitioners
Practice locations: Panama City, FL

National Provider Directory

National Provider Directory
Tax ID family
Bay Radiology Women's Imaging Center LLC2 organizations share this tax ID, including this one
Part of
Bay Radiology Associate

Other organizations with this tax ID 1

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

Locations

330 W 23rd St
Panama City, FL 32405
Phone (850) 763-2451

330 W 23rd St
Ste A
Panama City, FL 32405
Phone (850) 763-2451

521 N Palo Alto Ave
Panama City, FL 32401
Phone (850) 763-7458

527 N Palo Alto Ave
Panama City, FL 32401
Phone (850) 763-2451

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1720238769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1770",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324021770",
            "telephone_number": "850-747-4905",
            "fax_number": "850-747-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W. 23RD ST.",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324057614",
            "telephone_number": "850-763-2451",
            "fax_number": "850-747-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY RADIOLOGY WOMENS IMAGING CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY RADIOLOGY ASSOCIATES, PL",
        "enumeration_date": "2008-09-26",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "LOGUE",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-763-2451",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "V2983",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000969700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.