Great Lakes Medical Imaging LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

GREAT LAKES MEDICAL IMAGING LLC

Practice address

111 N Maplemere Rd Ste 120
Williamsville, NY 14221-3178

Phone

(716) 836-4646

Fax

(716) 836-4696

NPI assigned

Jan 19, 2012

Last updated

Aug 21, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth D Pearsen, MDNPI 1154387918

Title

MD

Phone

(716) 836-4646

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 60

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.

• Kenneth D Pearsen, MD

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1154387918
  Medicare reassignment Care Compare group NPD Authorized official
• Phillip Adam Baum, MD

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1023016060
  Medicare reassignment Care Compare group NPD
• Thomas Bevilacqua, M.D.

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1093094005
  Medicare reassignment Care Compare group NPD
• Jacob Chenez, DO

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1013479039
  Medicare reassignment Care Compare group NPD
• Harris Chengazi, M.D.

  • Vascular & Interventional Radiology Physician
  • Williamsville, NY
  • NPI 1861878837

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Omar Chohan, D.O.

  • Vascular & Interventional Radiology Physician
  • Williamsville, NY
  • NPI 1154764918

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• David Cipolla, M.D.

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1740422708
  Medicare reassignment Care Compare group NPD
• Adam Joseph Cole, M.D.

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1427336957
  Medicare reassignment Care Compare group NPD
• Mark Diiulio, MD

  • Vascular & Interventional Radiology Physician
  • Williamsville, NY
  • NPI 1063875763

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Douglas S. Drumsta, M.D.

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1124345566
  Medicare reassignment Care Compare group NPD
• Andrew T Dunn, MD

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1346367935
  Medicare reassignment Care Compare group NPD
• Hari Gopal, M.D.

  • Diagnostic Radiology Physician
  • Williamsville, NY
  • NPI 1336138502
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1861763005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD STE 120",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213178",
            "telephone_number": "716-836-4646",
            "fax_number": "716-836-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD STE 120",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213178",
            "telephone_number": "716-836-4646",
            "fax_number": "716-836-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICAL IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-19",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "PEARSEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "716-836-4646",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03428622",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan David Grant, MBBS
• Jacob Graue
• Graziano & Tagouri LLP
• Frank Leo Graziano Jr., DDS
• Mackenzie Graziano
• Natalie Grecco, LLMSW
• Inna Greco, RN
• Natalie Rose Greco, RD, CDN, CDE
• Melissa Green, RN
• Charles R Greenberg, PHARM.D.

• Diagnostic Radiology Physician in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.