NPIMap

Organization Active NPI

Tri-City Petct LLC

  • Radiology Clinic/Center
  • Vista, CA
National Provider Identifier
1154580348
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
TRI-CITY PETCT LLC
Practice address
902 Sycamore Ave
Vista, CA 92081
Phone
(714) 688-3384
NPI assigned
Jun 3, 2008
Last updated
Jul 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Authorized official

Name
Laura Kassa
Title
Sr Vice President
Phone
(904) 300-2777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X CA Primary

Addresses

Primary practice location

902 Sycamore Ave
Vista, CA 92081

Mailing address

8300 W Sunrise Blvd
Plantation, FL 33322-5406

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090429000226 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2062560147 Practice locations: Vista, CA

National Provider Directory

National Provider Directory

Member of 1

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

Locations

902 Sycamore Ave
Vista, CA 92081
Phone (714) 688-3384

902 Sycamore Ave
Ste 120
Vista, CA 92081
Phone (760) 599-9940

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1154580348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 W SUNRISE BLVD",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333225406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 SYCAMORE AVE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "92081",
            "telephone_number": "714-688-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-CITY PETCT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "KASSA",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "SR VICE PRESIDENT",
        "authorized_official_telephone_number": "904-300-2777"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.