NPIMap

Organization Active NPI

Summerlin Imaging Center LLC

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1316596471
Registry record updated Mar 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SUMMERLIN IMAGING CENTER LLC
Practice address
3550 University Blvd S Ste 102
Jacksonville, FL 32216-4227
Phone
(561) 331-0808
NPI assigned
Sep 10, 2019
Last updated
Mar 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2020

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

Authorized official

Name
Bradford G Peters
Title
Financial Officer
Phone
(561) 331-0808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

3550 University Blvd S Ste 102
Jacksonville, FL 32216-4227

Mailing address

6415 Lake Worth Rd Ste 102
Greenacres, FL 33463-3009
Phone (561) 331-0808

Other names 1

  • Jacksonville Diagnostic Imaging Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201103002044 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1153307947 Practice locations: Jacksonville, FL

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
Gainesville Diagnostic Imaging3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

20 Barkley Cir
Ste 104
Fort Myers, FL 33907
Phone (239) 425-0370

7520 W University Ave
Ste D
Gainesville, FL 32607
Phone (352) 505-6339

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1316596471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 LAKE WORTH RD STE 102",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334633009",
            "telephone_number": "561-331-0808",
            "fax_number": "561-237-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 UNIVERSITY BLVD S STE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164227",
            "telephone_number": "561-331-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERLIN IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "FINANCIAL OFFICER",
        "authorized_official_telephone_number": "561-331-0808"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Diagnostic Imaging",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jacksonville Diagnostic Imaging",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; 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.