Lebanon Pet Scan Center, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

LEBANON PET SCAN CENTER, LLC

Practice address

103 Physicians Way Ste 100
Lebanon, TN 37090-4129

Phone

(615) 329-0570

NPI assigned

Feb 28, 2020

Last updated

Feb 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pattie Douglas

Title

Payer Relations Manager

Phone

(615) 514-6876

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Tennessee Oncology PLLC

  • Hematology & Oncology Physician
  • Gallatin, TN
  • NPI 1124086939

  Member Of

  NPD member

Practitioners 44

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.

• Jack R Baker, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1699752493
  Medicare reassignment NPD
• Brian L Berger, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1396721106
  Medicare reassignment NPD
• Kartik Boorgu, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1689616294
  Medicare reassignment NPD
• Steven Brian Bush, M.D.

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1932148244
  Medicare reassignment NPD
• Anthony Crumel Disher, M.D.

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1104804145
  Medicare reassignment NPD
• Samuel Walton Fairbrother

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1346530284
  Medicare reassignment NPD
• Ellis L Goodin, M.D.

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1790762219
  Medicare reassignment NPD
• Scott D Gray, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1396729091
  Medicare reassignment NPD
• Kenneth Hawkins, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1245325422
  Medicare reassignment NPD
• Josh M Heck, M.D.

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1962636068
  Medicare reassignment NPD
• James T Holbrook, MD

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1245215649
  Medicare reassignment NPD
• Colby Jordan Jones, DO

  • Diagnostic Radiology Physician
  • Nashville, TN
  • NPI 1861913790
  Medicare reassignment NPD

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1114551132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 440149",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "37244",
            "telephone_number": "615-329-0570",
            "fax_number": "615-329-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 PHYSICIANS WAY STE 100",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370904129",
            "telephone_number": "615-329-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON PET SCAN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-28",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "PATTIE",
        "authorized_official_title_or_position": "PAYER RELATIONS MANAGER",
        "authorized_official_telephone_number": "615-514-6876"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lebanon Hma Physician Management LLC
• Lebanon Hma Surgery Center Inc (Lebanon Surgical Center)
• Lebanon Hma, LLC (University Medical Center)
• Lebanon Operator LLC (Wilson Manor)
• Lebanon Pediatric Dentistry, LLC
• Lebanon Radiation Oncology Center
• Lebanon Special School District
• Lebanon Surgicenter, LLC (Lebanon Center for Outpatient Surgery)
• Jodi Ledford, NP
• Stephen Christopher Lee, DO

• Diagnostic Radiology Physician in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Diagnostic Radiology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; 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.