NPIMap

Organization Active NPI

Medical Diagnostic Imaging PLLC

  • Radiology Clinic/Center
  • Poughkeepsie, NY
National Provider Identifier
1760435291
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MEDICAL DIAGNOSTIC IMAGING PLLC
Practice address
14 Raymond Ave
Poughkeepsie, NY 12603-2312
Phone
(845) 471-2848
Fax
(845) 471-2919
NPI assigned
May 18, 2006
Last updated
Dec 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

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

Authorized official

Name
Michael Waldman, MDNPI 1467434613
Title
President
Phone
(203) 818-1165

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

14 Raymond Ave
Poughkeepsie, NY 12603-2312

Mailing address

14 Raymond Ave
Poughkeepsie, NY 12603-2312
Phone (845) 471-2848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL, NJ, LA, NC, PA, MO, MD, AZ9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20040605000160 NY Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 24 practitioners
Practice locations: Poughkeepsie, NY; Yorktown Heights, NY; Wappingers Falls, NY; Tarrytown, NY; Port Washington, NY; New Rochelle, NY; Lagrangeville, NY; Ithaca, NY…
O20230912003843 FL Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 2 practitioners
Practice locations: Delray Beach, FL; Palm Beach Gardens, FL
O20231108001391 NJ Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 5 practitioners
Practice locations: Bergenfield, NJ; Fair Lawn, NJ; Mendham, NJ; Ringwood, NJ; Upper Saddle River, NJ
O20231121002643 LA Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 1 practitioner
Practice locations: Covington, LA
O20240411003551 NC Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 2 practitioners
Practice locations: Charlotte, NC; Waxhaw, NC
O20240926002467 PA Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 2 practitioners
Practice locations: Allentown, PA; Sewickley, PA
O20241227000199 MO Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 1 practitioner
Practice locations: Frontenac, MO
O20250925004967 MD Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 1 practitioner
Practice locations: Clarksville, MD
O20251223001763 AZ Part B Supplier - Clinic/Group Practice 0547242224 Receives reassigned benefits from 1 practitioner
Practice locations: Tucson, AZ

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
33D2002115Medical Diagnostic Imaging, PLLC14 Raymond Avenue, Poughkeepsie, NY 12603Certificate of waiverJan 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Medical Diagnostic Imaging2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734652800000",
    "number": "1760435291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 RAYMOND AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032312",
            "telephone_number": "845-471-2848",
            "fax_number": "845-471-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RAYMOND AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032312",
            "telephone_number": "845-471-2848",
            "fax_number": "845-471-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC IMAGING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A",
        "authorized_official_last_name": "WALDMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-818-1165",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; 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.