OrganizationActive
Boulevard Diagnostic Management Group, LLC
NPI 1194061135 · Magnetic Resonance Imaging (MRI) Clinic/Center · Southlake, TX
Provider details
- NPI number
- 1194061135
- Entity type
- Organization
- Primary specialty
- Magnetic Resonance Imaging (MRI) Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- James Waller, Managing Manager(817) 528-7044
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(78/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3120 W Southlake Blvd
Southlake, TX 76092-6783
Phone: (817) 741-0808
Street-level locationGet directions
Mailing address
3120 W Southlake Blvd
Southlake, TX 76092-6783
Registry dates
- Enumerated
- 2012-12-19
- Last updated
- 2012-12-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.