NPIMap

Organization Active NPI

East Central Florida Outpatient Imaging, LLC

Doing business as Saint Augustine Imaging Center

  • Diagnostic Radiology Physician
  • St Augustine, FL
National Provider Identifier
1760424071
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
EAST CENTRAL FLORIDA OUTPATIENT IMAGING, LLC
Doing business as
Saint Augustine Imaging Center
Practice address
190 Southpark Blvd
Suite 101
St Augustine, FL 32086-4120
Phone
(904) 829-0764
Fax
(904) 829-2221
NPI assigned
Jun 12, 2006
Last updated
Feb 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Authorized official

Name
Mr. Al Falco
Title
Ceo
Phone
(386) 274-7118

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X FL
Neuroradiology Physician 2085N0700X FL
Nuclear Radiology Physician 2085N0904X FL
Pediatric Radiology Physician 2085P0229X FL
Diagnostic Radiology Physician 2085R0202X FL Primary
Therapeutic Radiology Physician 2085R0203X FL
Vascular & Interventional Radiology Physician 2085R0204X FL
Diagnostic Ultrasound Physician 2085U0001X FL

Addresses

Primary practice location

190 Southpark Blvd
Suite 101
St Augustine, FL 32086-4120

Mailing address

1673 Mason Ave
Suite 305
Daytona Beach, FL 32117-5515
Phone (386) 274-7118

Other identifiers 1

IdentifierTypeStateIssuer
V2739OtherFLBLUE CROSS

Other names 1

  • Saint Augustine Imaging Center 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
10D2238896St Augustine Imaging190 Southpark Blvd Ste 101, Saint Augustine, FL 32086Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Central Florida Outpatient Imaging LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

190 Southpark Blvd
Ste 101
St Augustine, FL 32086
Phone (904) 827-9191

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": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1760424071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 MASON AVE",
            "address_2": "SUITE 305",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175515",
            "telephone_number": "386-274-7118",
            "fax_number": "386-274-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 SOUTHPARK BLVD",
            "address_2": "SUITE 101",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864120",
            "telephone_number": "904-829-0764",
            "fax_number": "904-829-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL FLORIDA OUTPATIENT IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "FALCO",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-274-7118",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V2739",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Augustine Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; 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.