CEDAR LAKE OPEN MRI LLC
Complete NPI Record 1992078950
Radiology - Diagnostic Radiology in Biloxi, MS
Active since February 21, 2012
Complete NPI Dataset
This page contains the complete raw NPPES record for Cedar Lake Open Mri Llc (NPI 1992078950), a radiology organization in Biloxi, MS. All 31 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1992078950 Field 1/31
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/31
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/31
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: CEDAR LAKE OPEN MRI LLC Field 4/31
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/31
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/31
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 6300 E LAKE BLVD STE 301 Field 7/31
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: VANCLEAVE Field 8/31
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MS Field 9/31
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 395656771 Field 10/31
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/31
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 2283540251 Field 12/31
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 2283963550 Field 13/31
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1720C MEDICAL PARK DR Field 14/31
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: BILOXI Field 15/31
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MS Field 16/31
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 395322131 Field 17/31
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/31
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2283540251 Field 19/31
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2283963550 Field 20/31
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: GARY Field 23/31
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: CHRYSTAL Field 24/31
- The first name of the authorized official.
- Authorized Official Title or Position: DIRECTOR OF IMAGING Field 25/31
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2284474674 Field 26/31
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 2085R0202X Field 27/31
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 28/31
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 29/31
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 30/31
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Cedar Lake MRI Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 1
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
6300B E Lake Blvd
Location 1/1Vancleave, MS 39565-6769 · Phone (228) 447-4674
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