NPIMap

Organization Active NPI

Portable Medical Diagnostics LLC

  • Mobile Radiology Clinic/Center
  • Jackson, MS
National Provider Identifier
1174804355
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
Legal business name
PORTABLE MEDICAL DIAGNOSTICS LLC
Practice address
1855 Lakeland Dr
Ste G10
Jackson, MS 39216-4926
Phone
(601) 987-9729
Fax
(601) 987-0093
NPI assigned
Sep 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Authorized official

Name
Douglas Brown
Title
Managing Partner
Phone
(601) 260-6008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Radiology Clinic/Center 261QR0208X MS Primary

Addresses

Primary practice location

1855 Lakeland Dr
Ste G10
Jackson, MS 39216-4926

Mailing address

1855 Lakeland Dr
Ste G10
Jackson, MS 39216-4926
Phone (601) 987-9729

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130808000880 MS Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1052585049 Practice locations: Ridgeland, MS

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Portable Medical Diagnostics LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 Fontaine Pl
Ste 103
Ridgeland, MS 39157
Phone (601) 987-9729

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1174804355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "STE G10",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164926",
            "telephone_number": "601-987-9729",
            "fax_number": "601-987-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "STE G10",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164926",
            "telephone_number": "601-987-9729",
            "fax_number": "601-987-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE MEDICAL DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "601-260-6008"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.