GREAT LAKES MEDICAL IMAGING LLC
NPI 1861763005
Radiology - Diagnostic Radiology in Williamsville, NY

NPI Status: Active since January 19, 2012

Contact Information

111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY
ZIP 14221
Phone: (716) 836-4646
Fax: (716) 836-4696

NPI Profile Information
Primary Taxonomy
Group Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Radiology
Diagnostic Radiology
CLIA Number: 33D2018926
CLIA Cert. Type: Other - IMAGING CENTER
CLIA Exp. Date: 03-26-2027

About GREAT LAKES MEDICAL IMAGING LLC

This page provides the complete NPI Profile along with additional information for Great Lakes Medical Imaging Llc, a provider established in Williamsville, New York operating as a Radiology, focusing in diagnostic radiology . The healthcare provider is registered in the NPI registry with number 1861763005 assigned on January 2012. The practitioner's primary taxonomy code is 2085R0202X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Kenneth D Pearsen Md (Md)

NPI: 1861763005
Provider Name: GREAT LAKES MEDICAL IMAGING LLC
Entity Type: Organization
Location Address: 111 N MAPLEMERE RD STE 120 WILLIAMSVILLE, NY 14221
Location Phone: (716) 836-4646
Location Fax: (716) 836-4696
Mailing Address: 111 N MAPLEMERE RD STE 120 WILLIAMSVILLE, NY 14221
Mailing Phone: (716) 836-4646
Mailing Fax: (716) 836-4696
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 01-19-2012
Last Update Date: 08-21-2023
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Radiology Diagnostic Radiology
Taxonomy Code: 2085R0202X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: KENNETH D PEARSEN MD
Authorized Official Title: MD
Authorized Official Phone: (716) 836-4646

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
03428622	MEDICAID (05)	NY

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 33D2018926
Facility Type: Other - IMAGING CENTER
Certificate Effective Date: January 19, 2011
Certificate Expiration Date: March 26, 2027
Laboratory Director: DR. JAMES J. RINALDI
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Great Lakes Medical Imaging Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1861763005, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 12 → 1 + 2

Pos 4

Unchanged

Pos 5

Doubled → 14 → 1 + 4

Pos 6

Unchanged

Pos 7

Doubled → 6

Pos 8

Unchanged

Pos 9

Doubled → 0

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 6 → 12 → 3 7 → 14 → 5 3 → 6 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 1 + 2 + 1 + 1 + 4 + 6 + 6 + 0 + 0 + 24 = 55

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 55 is 60. The difference is the calculated check digit.

60 - 55 = 5

This NPI is valid

The calculated check digit is 5, which matches the last digit of 1861763005.