NPIMap

Organization Active NPI

Diversity MRI LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Plantation, FL
National Provider Identifier
1346746179
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
L17000172498 Issued in FL
Legal business name
DIVERSITY MRI LLC
Practice address
801 S University Dr Ste K103A
Plantation, FL 33324-3367
Phone
(954) 905-7217
Fax
(954) 905-7217
NPI assigned
Apr 2, 2018
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Joshua A Ruskin
Title
Owner
Phone
(954) 347-2242

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X L17000172498 FL
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X L17000172498 FL Primary

Addresses

Primary practice location

801 S University Dr Ste K103A
Plantation, FL 33324-3367

Mailing address

801 S University Dr Ste K103A
Plantation, FL 33324-3367
Phone (954) 905-7217

Other identifiers 1

IdentifierTypeStateIssuer
121391600MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230523003118 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 6901262534 Practice locations: Plantation, FL

National Provider Directory

National Provider Directory

Locations

398 Camino Gardens Blvd
Ste 102
Boca Raton, FL 33432
Phone (561) 929-9104

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1346746179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S UNIVERSITY DR STE K103A",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243367",
            "telephone_number": "954-905-7217",
            "fax_number": "954-905-7218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S UNIVERSITY DR STE K103A",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243367",
            "telephone_number": "954-905-7217",
            "fax_number": "954-905-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSITY MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-02",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "RUSKIN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-347-2242"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "L17000172498",
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "FL",
            "license": "L17000172498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121391600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.