Organization Active NPI

MD Diagnostic Specialist, LLC

  • Specialist
  • Maitland, FL
National Provider Identifier
1285744870
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MD DIAGNOSTIC SPECIALIST, LLC
Practice address
668 N Orlando Ave
Suite 1005
Maitland, FL 32751-4473
Phone
(407) 740-8848
Fax
(407) 740-0324
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Authorized official

Name
Peter E. Weinberg, MD
Title
Director
Phone
(407) 740-8848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

668 N Orlando Ave
Suite 1005
Maitland, FL 32751-4473

Mailing address

668 N Orlando Ave
Suite 1005
Maitland, FL 32751-4473
Phone (407) 740-8848

Other identifiers 2

IdentifierTypeStateIssuer
V3206OtherFLBCBS
9376098OtherFLAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070112000333 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9830199942 Practice locations: Maitland, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1285744870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "668 N ORLANDO AVE",
            "address_2": "SUITE 1005",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514473",
            "telephone_number": "407-740-8848",
            "fax_number": "407-740-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "668 N ORLANDO AVE",
            "address_2": "SUITE 1005",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514473",
            "telephone_number": "407-740-8848",
            "fax_number": "407-740-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD DIAGNOSTIC SPECIALIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "WEINBERG",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "407-740-8848",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "V3206",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9376098",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.