Active NPI
Comprehensive Radiation Oncology, LLC
- Radiation Oncology Physician
- Palm Springs, FL
National Provider Identifier
1306338090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- Legal business name
- COMPREHENSIVE RADIATION ONCOLOGY, LLC
- Practice address
- 4685 S Congress Ave
Palm Springs, FL 33461-4761 - Phone
- (561) 548-2662
- Fax
- (561) 548-1633
- NPI assigned
- May 30, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. W. Tederick Johnson
- Title
- Group VP/Authorized Official
- Phone
- (615) 372-3375
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | Primary |
Addresses
Primary practice location
4685 S Congress Ave
Palm Springs, FL 33461-4761
Mailing address
2000 Health Park Dr
Brentwood, TN 37027-4525
Phone (615) 372-5426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190221002678 | FL | Part B Supplier - Clinic/Group Practice | 4688913494 |
Receives reassigned benefits from 2 practitioners Practice locations: Atlantis, FL; West Palm Beach, FL; Palm Springs, FL; Miami, FL; Loxahatchee Groves, FL; Aventura, FL |
National Provider Directory
National Provider DirectoryNetworks
- HealthSun Health Plans Network
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": "1527638400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1623628800000",
"number": "1306338090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 HEALTH PARK DR",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370274525",
"telephone_number": "615-372-5426",
"fax_number": "866-700-8452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4685 S CONGRESS AVE",
"city": "PALM SPRINGS",
"state": "FL",
"postal_code": "334614761",
"telephone_number": "561-548-2662",
"fax_number": "561-548-1633"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMPREHENSIVE RADIATION ONCOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-05-30",
"last_updated": "2021-06-14",
"certification_date": "2021-06-14",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "W. TEDERICK",
"authorized_official_title_or_position": "GROUP VP/AUTHORIZED OFFICIAL",
"authorized_official_telephone_number": "615-372-3375",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.