NPIMap

Organization Active NPI

Peninsula Rad Onc Ctr LLC

  • Radiology Clinic/Center
  • Gig Harbor, WA
National Provider Identifier
1366694796
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
PENINSULA RAD ONC CTR LLC
Practice address
11511 Canterwood Blvd Ste 50
Gig Harbor, WA 98332-5816
Phone
(253) 779-6325
Fax
(253) 627-8792
NPI assigned
Oct 16, 2008
Last updated
Sep 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Authorized official

Name
Mrs. Betty Sable
Title
Cfo
Phone
(253) 779-6325

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X WA Primary
Radiation Oncology Physician 2085R0001X NU

Addresses

Primary practice location

11511 Canterwood Blvd Ste 50
Gig Harbor, WA 98332-5816

Mailing address

4230 Bridgeport Way W Ste B
University Place, WA 98466-4335
Phone (253) 779-6325

Other identifiers 2

IdentifierTypeStateIssuer
7144793MedicaidWA
8949842OtherWAL&I CRIME VICTIMS

Other names 1

  • TACOMA RAD ONC CTR INC MBR Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tacomaradiation@directaddress.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090203000240 WA Part B Supplier - Radiation Therapy Center 6204990450 Receives reassigned benefits from 11 practitioners
Practice locations: Gig Harbor, WA

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4230 Bridgeport Way W
Ste B
University Place, WA 98466
Phone (253) 272-1077

Interoperability endpoints

  • Direct secure messaging: tacomaradiation@directaddress.net

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1366694796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 BRIDGEPORT WAY W STE B",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664335",
            "telephone_number": "253-779-6325",
            "fax_number": "253-627-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11511 CANTERWOOD BLVD STE 50",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983325816",
            "telephone_number": "253-779-6325",
            "fax_number": "253-627-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA RAD ONC CTR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "SABLE",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "253-779-6325",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7144793",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I CRIME VICTIMS",
            "identifier": "8949842",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tacomaradiation@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "CCDA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11511 Canterwood Blvd Ste 50",
            "city": "Gig Harbor",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983325816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "TACOMA RAD ONC CTR INC MBR",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TACOMA RAD ONC CTR INC MBR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gig Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.