NPIMap

Organization Active NPI

Florida Radiology Imaging at Lake Mary LLC

Doing business as AdventHealth Imaging Waterford Lakes

  • Diagnostic Radiology Physician
  • Orlando, FL
National Provider Identifier
1851414023
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Doing business as
AdventHealth Imaging Waterford Lakes
Florida Radiology Imaging at Waterford Lakes
Practice address
12301 Lake Underhill Road
Suite 103
Orlando, FL 32828
Phone
(407) 834-8722
NPI assigned
Apr 10, 2007
Last updated
Jun 20, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Authorized official

Name
Pedro Rodriguez, M.D.
Title
Medical Director
Phone
(407) 949-6444

Specialties & licenses 6

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

Addresses

Primary practice location

12301 Lake Underhill Road
Suite 103
Orlando, FL 32828

Mailing address

900 Winderley PL Ste 2100
Maitland, FL 32751-4191
Phone (407) 767-5028

Other identifiers 2

IdentifierTypeStateIssuer
2656442 04MedicaidFL
1740256494OtherFLNPI BASE FOR GROUP

Other names 2

  • AdventHealth Imaging Waterford Lakes Doing business as
  • Florida Radiology Imaging at Waterford Lakes Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721001414 FL Part B Supplier - Clinic/Group Practice 1254311137 Receives reassigned benefits from 420 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orlando, FL; Oviedo, FL; Palm Beach Gardens, FL; Parkland, FL; Port Orange, FL; Vero Beach, FL; Weston, FL; Wilton Manors, FL…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Florida Radiology LLC12 organizations share this tax ID, including this one
Part of
Florida Radiology LLC

Other organizations with this tax ID 11

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

Locations

12301 Lake Underhill Rd
Ste 103
Orlando, FL 32828
Phone (407) 834-8722

12301 Lake Underhill Rd
Ste 113
Orlando, FL 32828
Phone (407) 949-6444

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1851414023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WINDERLEY PL STE 2100",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514191",
            "telephone_number": "407-767-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 LAKE UNDERHILL ROAD",
            "address_2": "SUITE 103",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32828",
            "telephone_number": "407-834-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC",
        "enumeration_date": "2007-04-10",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-949-6444",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2656442 04",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI BASE FOR GROUP",
            "identifier": "1740256494",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Imaging Waterford Lakes",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida Radiology Imaging at Waterford Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.