NPIMap

Organization Active NPI

South Alabama Diagnostic Imaging PC

Doing business as John C Tomberlin

  • Diagnostic Radiology Physician
  • Bonifay, FL
National Provider Identifier
1437332947
Registry record updated Jun 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME60438 Issued in FL
Legal business name
SOUTH ALABAMA DIAGNOSTIC IMAGING PC
Doing business as
John C Tomberlin
Practice address
2600 Hospital Dr
Bonifay, FL 32425-4264
Phone
(334) 684-7156
NPI assigned
Dec 7, 2007
Last updated
Jun 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2019

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

Authorized official

Name
Dr. John C Tomberlin, MDNPI 1275511370
Title
Radiologist
Phone
(334) 684-7156

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME60438 FL Primary

Addresses

Primary practice location

2600 Hospital Dr
Bonifay, FL 32425-4264

Mailing address

PO Box 1928
Bainbridge, GA 39818-1928
Phone (334) 684-3655

Other identifiers 3

IdentifierTypeStateIssuer
047944602MedicaidFL
047944603MedicaidFL
047944604MedicaidFL

Other names 1

  • John C Tomberlin Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081216000681 FL Part B Supplier - Clinic/Group Practice 4688562994 Receives reassigned benefits from 1 practitioner
Practice locations: Panama City, FL; Bonifay, FL; Niceville, FL; Marianna, FL; Defuniak Springs, FL; Graceville, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
John C Tomberlin3 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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1437332947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1928",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398181928",
            "telephone_number": "334-684-3655",
            "fax_number": "334-684-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 HOSPITAL DR",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324254264",
            "telephone_number": "334-684-7156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ALABAMA DIAGNOSTIC IMAGING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "TOMBERLIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "RADIOLOGIST",
        "authorized_official_telephone_number": "334-684-7156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME60438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047944602",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047944603",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047944604",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John C Tomberlin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "John C Tomberlin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonifay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; 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.