NPIMap

Organization Active NPI

Florida Radiology Imaging at Lake Mary LLC

Doing business as Florida Radiology Imaging at Oviedo

  • Diagnostic Radiology Physician
  • Oviedo, FL
National Provider Identifier
1891874699
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
Florida Radiology Imaging at Oviedo
Practice address
8000 Red Bug Lake Rd
Suite 120
Oviedo, FL 32765-9226
Phone
(407) 767-0433
NPI assigned
Nov 3, 2006
Last updated
Jun 20, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARYAs 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
Dr. Jack Berger, M.D.NPI 1710984240
Title
Medical Director
Phone
(407) 767-0433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085B0100X
Neuroradiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0700X
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X
Diagnostic Ultrasound PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

8000 Red Bug Lake Rd
Suite 120
Oviedo, FL 32765-9226

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
265644201MedicaidFL
V2787OtherFLBCBS GROUP # FOR LOCATION

Other names 1

  • Florida Radiology Imaging at Oviedo 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
Adventhealth Imaging12 organizations share this tax ID, including this one
Part of
Adventhealth Imaging

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1891874699",
    "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": "8000 RED BUG LAKE RD",
            "address_2": "SUITE 120",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327659226",
            "telephone_number": "407-767-0433"
        }
    ],
    "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",
        "enumeration_date": "2006-11-03",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "407-767-0433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265644201",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP # FOR LOCATION",
            "identifier": "V2787",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Radiology Imaging at Oviedo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oviedo, 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.