NPIMap

Organization Active NPI

Durham Diagnostic Imaging LLC

Doing business as Independence Park

  • Diagnostic Radiology Physician
  • Durham, NC
National Provider Identifier
1821046004
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DURHAM DIAGNOSTIC IMAGING LLC
Doing business as
Independence Park
Practice address
4323 Ben Franklin Blvd
Durham, NC 27704-2177
Phone
(919) 471-4840
Fax
(919) 321-1575
NPI assigned
May 4, 2006
Last updated
Mar 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Mr. Geoffrey K. Gardner
Title
SVP Finance and Revenue Cycle
Phone
(336) 718-2078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X NC Primary

Addresses

Primary practice location

4323 Ben Franklin Blvd
Durham, NC 27704-2177

Mailing address

PO Box 933393
Atlanta, GA 31193-0001
Phone (866) 659-1211

Other names 1

  • Independence Park Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000561 NC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4082505623 2 other NPIs on this enrollment
Practice locations: Durham, NC

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
34D0999196Durham Diagnostic Imaging4323 Ben Franklin Blvd, Durham, NC 27704Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Durham Diagnostic Imaging3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4323 Ben Franklin Blvd
Durham, NC 27704
Phone (919) 471-4840

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1821046004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933393",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311930001",
            "telephone_number": "866-659-1211",
            "fax_number": "336-774-1751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4323 BEN FRANKLIN BLVD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042177",
            "telephone_number": "919-471-4840",
            "fax_number": "919-321-1575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DURHAM DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "SVP FINANCE AND REVENUE CYCLE",
        "authorized_official_telephone_number": "336-718-2078",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

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