NPIMap

Organization Active NPI

Lakeland Radiologists P a

  • Diagnostic Radiology Physician
  • Jackson, MS
National Provider Identifier
1861428351
Registry record updated Oct 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LAKELAND RADIOLOGISTS P A
Practice address
969 Lakeland Dr
Jackson, MS 39216-4606
Phone
(601) 982-7878
Fax
(706) 596-6704
NPI assigned
Jun 25, 2006
Last updated
Oct 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2026

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

Authorized official

Name
Mr. George Ehrhardt
Title
Administrator
Phone
(601) 982-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

969 Lakeland Dr
Jackson, MS 39216-4606

Mailing address

PO Box 23073
Jackson, MS 39225-3073
Phone (601) 982-7878

Other identifiers 1

IdentifierTypeStateIssuer
09011377MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AZ, TN, SC, MO, CA6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20041006001125 MS Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 34 practitioners
Practice locations: Foxworth, MS; Laurel, MS; Madison, MS; McComb, MS; Monticello, MS; Philadelphia, MS; Ridgeland, MS; Summit, MS…
O20190409001928 AZ Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ; Scottsdale, AZ
O20190424002111 TN Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 2 practitioners
Practice locations: Chattanooga, TN
O20200622000669 SC Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 1 practitioner
Practice locations: Travelers Rest, SC
O20220901002410 MO Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 1 practitioner
Practice locations: Cape Girardeau, MO
O20240328002187 CA Part B Supplier - Clinic/Group Practice 4183683089 Receives reassigned benefits from 1 practitioner
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792195200000",
    "number": "1861428351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23073",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253073",
            "telephone_number": "601-982-7878",
            "fax_number": "705-596-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-982-7878",
            "fax_number": "706-596-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND RADIOLOGISTS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2026-10-17",
        "certification_date": "2026-10-17",
        "status": "A",
        "authorized_official_last_name": "EHRHARDT",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-982-7878",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09011377",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs RD Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2026; 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.