Cedar Lake Open MRI LLC
Organization Active NPI Diagnostic Radiology Physician · Biloxi, MS
NPI 1992078950 · NPPES record last updated Jan 21, 2026
Key facts
- NPI
- 1992078950
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- CEDAR LAKE OPEN MRI LLC
- Practice address
- 1720C Medical Park Dr
Biloxi, MS 39532-2131 - Phone
- (228) 354-0251
- Fax
- (228) 396-3550
- NPI assigned
- Feb 21, 2012
- Organization subpart
- No
Authorized official
- Name
- Chrystal Gary
- Title
- Director of Imaging
- Phone
- (228) 447-4674
Member organizations 1
Practitioners 5
-
Jeffrey Dean Noblin, M.D.
-
Lisa Mabry Smith, MD
-
Mark Burnette Wall, M.D.
-
Dustin Lee Yontz, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120910000069 | MS | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 5698747111 | Practice locations: Biloxi, MS |
| O20180815000926 | MS | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 5698747111 | Practice locations: Vancleave, MS |
National Provider Directory
Locations
1720C Medical Park Dr
Biloxi, MS 39532
Phone (228) 354-0251
6300 E Lake Blvd
#B
Vancleave, MS 39565
Phone (228) 447-4674
6300 E Lake Blvd
Ste 301
Vancleave, MS 39565
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
1720C Medical Park Dr
Biloxi, MS 39532-2131
Mailing address
6300 E Lake Blvd Ste 301
Vancleave, MS 39565-6771
Phone (228) 354-0251
Other practice location 1
6300B E Lake Blvd
Vancleave, MS 39565-6769
Phone (228) 447-4674
Other names
- Cedar Lake MRI
Other providers in Biloxi, MS
- Brian Wayne Caswell
- Alkini Roycestine Catchings
- Rene Hood Cathey
- Cedar Lake Chiropractic Inc.
- Cedar Lake Medical Center, PA
- Cedar Lake Pediatric Clinic PLLC
- Cedar Lake Pharmacy
- Cedar Lake Pharmacy
- Centerwell Senior Primary Care Ms CS PC
- Centerwell Senior Primary Care Ms PC
All providers in Biloxi, MS · Diagnostic Radiology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.