NPIMap

Organization Active NPI

Frederica Imaging PC

  • Diagnostic Radiology Physician
  • St Simons Island, GA
National Provider Identifier
1750775540
Registry record updated Mar 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FREDERICA IMAGING PC
Practice address
301 Hawkins Island Dr
Saint Simons Island, GA 31522-1506
Phone
(800) 841-4236
NPI assigned
Mar 19, 2015
Last updated
Mar 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2015

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

Authorized official

Name
Christopher DooleyNPI 1295709038
Title
MD
Phone
(800) 475-6236

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 NU Primary

Addresses

Primary practice location

301 Hawkins Island Dr
Saint Simons Island, GA 31522-1506

Mailing address

301 Hawkins Island Dr
Saint Simons Island, GA 31522-1506

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150622001807 GA Part B Supplier - Clinic/Group Practice 5395056055 Receives reassigned benefits from 29 practitioners
Practice locations: Brunswick, GA; Saint Marys, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427155200000",
    "number": "1750775540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HAWKINS ISLAND DR",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315221506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HAWKINS ISLAND DR",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315221506",
            "telephone_number": "800-841-4236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICA IMAGING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-19",
        "last_updated": "2015-03-24",
        "status": "A",
        "authorized_official_last_name": "DOOLEY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "800-475-6236"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Simons Island, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; 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.