DAYTONA MRI LLC (NPI# 1316309800) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316309800 |
| Entity Type | Organization |
| Organization Name | DAYTONA MRI LLC |
| Practice Address |
125 Mason Ave Daytona Beach FL 32117-5017 |
| Practice Telephone | 3864634444 |
| Practice Fax Number | 3863130304 |
| Mailing Telephone | 3864634444 |
| Mailing Fax Number | 3863130304 |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2017-05-31 |
| Authorized Official Name | DR. JOHNATHAN LIVINGSTON WAGNER (OWNER) |
| Authorized Official Telephone | 3864634444 |
| Authorized Official Credential | D.C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2471C3402X |
Radiologic Technologist Specialization: Radiography |
Technologists, Technicians & Other Technical Service Providers | ||
| N | 2471M1202X |
Radiologic Technologist Specialization: Magnetic Resonance Imaging |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | NPI TYPE 1 | 1881628220 | 01 |
| Street Address |
125 MASON AVE |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32117-5017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992350409 | Erin Selfridge | Pharmacist | 1500 Beville Rd #300, Daytona Beach, FL 32117 | 2019-08-02 |
| 1881185494 | Wellspring Health, LLC | Chiropractor | 701 Ridgewood Ave, Holly Hills, FL 32117 | 2018-05-21 |
| 1780172791 | L & L Db, LLC | Clinic/Center | 1540 Cornerstone Blvd, Suite 100, Daytona Beach, FL 32117 | 2018-04-25 |
| 1154837789 | Brittany Nikolow | Nurse Practitioner | 1717 N. Clyde Morris, Daytona Beach, FL 32117 | 2017-12-19 |
| 1205356946 | Alejandro Andre Pabon Rodriguez | Nurse Anesthetist, Certified Registered | Florida Hospital Memorial Medical Center, 301 Memorial Medical Parkway, Daytona Beach, FL 32117 | 2017-06-23 |
| 1316492135 | Ann Van Herck | Physical Therapist | 1901 Mason Ave Ste 105, Daytona Beach, FL 32117 | 2016-08-22 |
| 1952784779 | Kathryn Brenna Copley | Nurse Practitioner | 1890 Lpga Blvd., Daytona Beach, FL 32117 | 2015-06-30 |
| 1053719559 | Alicia Graham | Case Manager/Care Coordinator | 1570 Megan Bay Circle, Holly Hill, FL 32117 | 2014-12-15 |
| 1578974440 | Halifax Senior Care Inc | Clinic/Center | 1515 Ridgewood Ave, Suite B, Holly Hill, FL 32117 | 2014-05-14 |
| 1013345883 | Kist Alf, Inc | Assisted Living Facility | 1516 Carmen Avenue, Daytona Beach, FL 32117 | 2013-10-14 |
| Find all providers in zip 32117 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285240192 | Ohi West Medical Group, LLC | Physiological Laboratory | 2201 Central Ave Ste 100, St Petersburg, FL 33713-8844 | 2020-09-17 |
| 1619446853 | Myvy Southwest Imaging LLC | Physiological Laboratory | 1160 Kane Concourse Ste 402, Bay Harbor Is, FL 33154-2059 | 2018-11-16 |
| 1366919961 | Richard Thomas Escobar | Physiological Laboratory | 2111 S Pine Ave Ste B, Ocala, FL 34471-8194 | 2018-11-01 |
| 1316398787 | Braincare, LLC | Physiological Laboratory | 12301 Lake Underhill Rd Ste 201, Orlando, FL 32828-4511 | 2016-06-28 |
| 1124486931 | R&r Medx Solutions LLC | Physiological Laboratory | 7144 Stirling Rd, Ste 185, Hollywood, FL 33024-1650 | 2016-02-08 |
| 1730568486 | My Diagnostic Team Inc | Physiological Laboratory | 3114 45th St, Suite 9, West Palm Beach, FL 33407-1945 | 2015-05-28 |
| 1508260399 | Douglas Lyons | Physiological Laboratory | 1250 Diana Ave, Naples, FL 34103-4567 | 2014-10-22 |
| 1275956005 | University of South Florida | Physiological Laboratory | 3702 Spectrum Blvd, Suite 165, Tampa, FL 33612-9444 | 2014-01-30 |
| 1891125936 | Portable Medical Diagnostics, Inc | Physiological Laboratory | 8080 Belvedere Rd Ste 6, West Palm Beach, FL 33411-6224 | 2013-11-26 |
| 1083950752 | Beachway Therapy Treatment Center LLC | Physiological Laboratory | 705 Bond Way Ste B, Delray Beach, FL 33483-5826 | 2012-12-27 |
| Find all providers with the same taxonomy | ||||
| City | DAYTONA BEACH |
| Zip Code | 32117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.