NPIMap

Organization Active NPI

Portable Medical Diagnostics Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • West Palm Beach, FL
National Provider Identifier
1093759276
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X
License
HCC4152 Issued in FL
Legal business name
PORTABLE MEDICAL DIAGNOSTICS INC
Practice address
3540 Forest Hill Blvd Ste 112
West Palm Beach, FL 33406-5878
Phone
(561) 964-3311
Fax
(561) 964-3199
NPI assigned
Jun 16, 2006
Last updated
Apr 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Andrew Rosebrough
Title
Owner
Phone
(561) 964-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X HCC4152 FL Primary

Addresses

Primary practice location

3540 Forest Hill Blvd Ste 112
West Palm Beach, FL 33406-5878

Mailing address

3540 Forest Hill Blvd Ste 112
West Palm Beach, FL 33406-5878
Phone (561) 964-3311

Other identifiers 1

IdentifierTypeStateIssuer
030163900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091211000162 FL Part B Supplier - Portable X-Ray Supplier 2466521281 Practice locations: West Palm Beach, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1241 SE Indian St
Stuart, FL 34997
Phone (772) 781-2207

8140 Belvedere Rd
Ste 4
West Palm Beach, FL 33411
Phone (561) 964-3311

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1093759276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 FOREST HILL BLVD STE 112",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334065878",
            "telephone_number": "561-964-3311",
            "fax_number": "561-964-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 FOREST HILL BLVD STE 112",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334065878",
            "telephone_number": "561-964-3311",
            "fax_number": "561-964-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE MEDICAL DIAGNOSTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "ROSEBROUGH",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-964-3311"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "FL",
            "license": "HCC4152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030163900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.