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

Active since January 19, 2012CLIA 33D2018926 · Waiver
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221(716) 836-4646(716) 836-4696 Get Directions Write a Review

NPPES record last updated: August 21, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 21, 2023, Dec 17, 2020, Sep 25, 2018 (3 updates tracked since 2018).

About Great Lakes Medical Imaging Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES MEDICAL IMAGING LLC (NPI 1861763005) is a healthcare organization registered as a diagnostic radiology in Williamsville, New York and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Kenneth D Pearsen, Md, as its authorized official.

NPPES Registry Identity

NPI1861763005
Entity TypeOrganization
Primary Taxonomy2085R0202X
Legal Business NameGREAT LAKES MEDICAL IMAGING LLC
Location Address111 N MAPLEMERE RD STE 120Williamsville, NY 14221-3178
Mailing Address111 N Maplemere Rd Ste 120Williamsville, NY 14221-3178 · (716) 836-4646 · Fax (716) 836-4696
Phone(716) 836-4646
Fax(716) 836-4696
Organization SubpartNo
Authorized OfficialKenneth D PearsenMd · (716) 836-4646
Enumeration DateJanuary 19, 2012
Last NPPES UpdateAugust 21, 20233 updates tracked since enumeration
NPPES CertifiedAugust 21, 2023
✔ NPI 1861763005 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
111 N MAPLEMERE RD STE 120, Williamsville, NY 14221
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Other Identifiers 1

Medicaid03428622NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2018926

Great Lakes Medical Imaging LLC · Williamsville, NY
Active · expires Mar 26, 2027
CLIA Number33D2018926
Laboratory TypeImaging Center
Certificate Effective DateJanuary 19, 2011
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. James J. Rinaldi
Laboratory Phone(716) 836-4646
Laboratory LocationGreat Lakes Medical Imaging LLC111 North Maplemere - Suite 120, Williamsville, NY 14221
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JACOB CHENEZ DO
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
PHILLIP ADAM BAUM MD
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
DR. JAMES J RINALDI MD
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
MARK DIIULIO MD
Radiology (Vascular & Interventional Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
ROSEANNE OLIVERIO MD
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
THOMAS BEVILACQUA M.D.
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
FAISAL M SHAH MD
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646
DOUGLAS S. DRUMSTA M.D.
Radiology (Diagnostic Radiology)
111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY 14221
Erie County (716) 836-4646

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Medical Imaging LLC's NPI number?

The NPI number for Great Lakes Medical Imaging LLC is 1861763005. It was assigned to this organization in the NPPES registry on January 19, 2012.

Where is Great Lakes Medical Imaging LLC located?

Great Lakes Medical Imaging LLC is located at 111 N Maplemere Rd Ste 120, Williamsville, NY 14221. The listed phone number is (716) 836-4646.

What is Great Lakes Medical Imaging LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Does Great Lakes Medical Imaging LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2018926) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Great Lakes Medical Imaging LLC was last updated on August 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.