Organization Active NPI

Cedar Lake Open MRI LLC

Doing business as Cedar Lake MRI

  • Diagnostic Radiology Physician
  • Biloxi, MS
National Provider Identifier
1992078950
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CEDAR LAKE OPEN MRI LLC
Doing business as
Cedar Lake MRI
Practice address
1720C Medical Park Dr
Biloxi, MS 39532-2131
Phone
(228) 354-0251
Fax
(228) 396-3550
NPI assigned
Feb 21, 2012
Last updated
Jan 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

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

Authorized official

Name
Chrystal Gary
Title
Director of Imaging
Phone
(228) 447-4674

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

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 1

  • Cedar Lake MRI Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

6300 E Lake Blvd
#B
Vancleave, MS 39565
Phone (228) 447-4674

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1329782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768953600000",
    "number": "1992078950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 E LAKE BLVD STE 301",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395656771",
            "telephone_number": "228-354-0251",
            "fax_number": "228-396-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720C MEDICAL PARK DR",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322131",
            "telephone_number": "228-354-0251",
            "fax_number": "228-396-3550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6300B E Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Vancleave",
            "state": "MS",
            "postal_code": "395656769",
            "country_code": "US",
            "telephone_number": "228-447-4674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CEDAR LAKE OPEN MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-21",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A",
        "authorized_official_last_name": "GARY",
        "authorized_official_first_name": "CHRYSTAL",
        "authorized_official_title_or_position": "DIRECTOR OF IMAGING",
        "authorized_official_telephone_number": "228-447-4674"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Lake MRI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cedar Lake MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Biloxi, MS

Sources for this page

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