Great Lakes Medical Imaging LLC
NPI 1861763005ActiveOrganization· Radiology, Diagnostic Radiology· Williamsville, NY
Radiology, Diagnostic Radiology in Williamsville, New York, registered in NPPES in January 2012. The authorized official on file is Kenneth D. Pearsen, MD, Md. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1861763005 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 19, 2012 |
| Last updated in NPPES | Aug 21, 2023 |
| Certified by provider | Aug 21, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Radiology, Diagnostic Radiology Primary | 2085R0202X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NY) |
|---|
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