Tri County Pet LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

HCC5507 Issued in FL

Legal business name

TRI COUNTY PET LLC

Doing business as

PET Imaging Institute of South Fl.
TRI County PET, LLC

Practice address

2122 W. Cypress Creek Road
Suite 210
Fort Lauderdale, FL 33309

Phone

(954) 981-6668

NPI assigned

Mar 6, 2018

Organization subpart

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisette Cruz-Deno

Title

Managing Director

Phone

(954) 981-6668

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 2

• PET Imaging Institute of South Fl. Doing business as
• TRI County PET, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tri County Pet LLC

  dba PET Imaging Institute of South Florida

  • Radiology Clinic/Center
  • Hollywood, FL
  • NPI 1124020656

  O20120206000581

  Same enrollment
• Tri County Pet LLC

  dba PET Imaging Institute of South Florida

  • Radiology Clinic/Center
  • Pembroke Pines, FL
  • NPI 1760602510

  O20120206000581

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Neetha Gandikota MD

Networks

• HealthSun Health Plans Network

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barry Charnick, MD

  • Nuclear Radiology Physician
  • Fort Lauderdale, FL
  • NPI 1700889912
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523404800000",
    "number": "1003318049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE STE 665",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215432",
            "telephone_number": "954-981-6668",
            "fax_number": "954-981-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 W. CYPRESS CREEK ROAD",
            "address_2": "SUITE 210",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "33309",
            "telephone_number": "954-981-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY PET LLC",
        "organizational_subpart": "YES",
        "enumeration_date": "2018-03-06",
        "last_updated": "2018-04-11",
        "status": "A",
        "authorized_official_last_name": "CRUZ-DENO",
        "authorized_official_first_name": "LISETTE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "954-981-6668"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "FL",
            "license": "HCC5507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003906001",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003906000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "V2440",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PET Imaging Institute of South Fl.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TRI County PET, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Radiology Clinic/Center in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Radiology Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.