SUMMERLIN IMAGING CENTER LLC NPI 1720536154

NPI Information

  • NPI: 1720536154
  • Provider Name: SUMMERLIN IMAGING CENTER LLC
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Organization
  • Other Name: PARK AVENUE IMAGING
  • CLIA Number: 10D2121260
  • Address: 2128 PARK AVE
    ORANGE PARK, FL
    ZIP 32073
  • Phone: (904) 375-8884

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NPI Details

SUMMERLIN IMAGING CENTER LLC is a diagnostic radiology radiology in Orange Park, FL. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. SUMMERLIN IMAGING CENTER LLC NPI is 1720536154. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Park Avenue Imaging.

The provider's business location address is:

2128 PARK AVE
ORANGE PARK, FL
ZIP 32073
Phone: (904) 375-8884
Fax: (904) 375-8887

The provider's authorized official is Bradford Peters .
The authorized official title is Cfo and has the following contact phone number (561) 331-0808.

The CLIA number assigned to this NPI record is 10D2121260 - other - outpatient imaging with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Mri scan of lower spinal canal without contrast (HCPCS:72148)
  • X-ray of lower and sacral spine, minimum of 4 views (HCPCS:72110)
  • X-ray of chest, 2 views (HCPCS:71046)
  • Mri scan of leg joint without contrast (HCPCS:73721)
  • X-ray of lower and sacral spine, 2-3 views (HCPCS:72100)
  • Mri scan of upper spinal canal without contrast (HCPCS:72141)
  • Mri scan of middle spinal canal without contrast (HCPCS:72146)

The enumeration date for this NPI number is 9/14/2016 and was last updated on 8/25/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1HCC10650OTHERFLORIDAAHCC LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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