NPIMap

Organization Active NPI

Eastside P.E.T. Center, LLC

Doing business as UAB St. Vincent's East P.E.T. Center

  • Diagnostic Radiology Physician
  • Birmingham, AL
National Provider Identifier
1619925070
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
EASTSIDE P.E.T. CENTER, LLC
Doing business as
UAB St. Vincent's East P.E.T. Center
Practice address
46 Medical Park Dr E
Ste 224
Birmingham, AL 35235-3401
Phone
(205) 838-3738
Fax
(205) 838-6738
NPI assigned
May 5, 2006
Last updated
Jun 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Authorized official

Name
Lisa J. Wells, CPCO
Title
Vice-President
Phone
(205) 221-8258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

46 Medical Park Dr E
Ste 224
Birmingham, AL 35235-3401

Mailing address

406 Medical Center Dr
Jasper, AL 35501-3400
Phone (205) 221-8200

Other names 1

  • UAB St. Vincent's East P.E.T. Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070219000628 AL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2860594090 Receives reassigned benefits from 1 practitioner
Practice locations: Birmingham, AL

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

Member of 1

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

Locations

46 Medical Park Dr E
Ste 224
Birmingham, AL 35235
Phone (205) 838-3738

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1619925070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 MEDICAL CENTER DR",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355013400",
            "telephone_number": "205-221-8200",
            "fax_number": "205-221-8270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 MEDICAL PARK DR E",
            "address_2": "STE 224",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353401",
            "telephone_number": "205-838-3738",
            "fax_number": "205-838-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE P.E.T. CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "205-221-8258",
        "authorized_official_credential": "CPCO"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UAB St. Vincent's East P.E.T. Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; 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.