Institute of Diagnostic Imaging,LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

602617 Issued in FL

Legal business name

INSTITUTE OF DIAGNOSTIC IMAGING,LLC

Practice address

424 Racetrack Rd NW
Ft Walton Beach, FL 32547-1556

Phone

(850) 314-7575

Fax

(850) 314-7494

NPI assigned

Feb 28, 2006

Organization subpart

No

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

Authorized official

Name

Laurie Borgstrom

Title

Office Manager

Phone

(850) 314-7575

Specialties & licenses 1

Addresses

Other identifiers 2

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

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Neville R. Wichman, M.D.

  • Diagnostic Radiology Physician
  • Jackson, MS
  • NPI 1437121134
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403222400000",
    "number": "1982670022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 RACETRACK RD NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471556",
            "telephone_number": "850-314-7575",
            "fax_number": "850-314-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 RACETRACK RD NW",
            "city": "FT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471556",
            "telephone_number": "850-314-7575",
            "fax_number": "850-314-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF DIAGNOSTIC IMAGING,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "BORGSTROM",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "850-314-7575"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "602617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB5733",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268363600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann E Imburgio, L.M.H.C.
• Amanda Leigh Imperato, MSN, APRN, AGACNP-BC
• In Your Dreams International Inc
• In Your Dreams International Inc
• Infinite Grace Academy
• Integrated Regional Laboratories Pathology Services, LLC
• Integrated Regional Laboratories Pathology Services, LLC
• Integrated Wellness Behavioral Health PA
• Interim Healthcare of NW FL Inc
• Its All About You Massage and Day Spa

• Diagnostic Radiology Physician in Ft Walton Beach, FL
• Providers in Ft Walton Beach, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.