Eastside P.E.T. Center, LLC

Primary specialty

Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X

Legal business name

EASTSIDE P.E.T. CENTER, LLC

Doing business as

UAB Medicine Sleep Center at One Nineteen

Practice address

7191 Cahaba Valley Rd
BLDG 2 Ste 203
Hoover, AL 35242-6448

Phone

(205) 236-9943

Fax

(205) 236-9947

NPI assigned

Mar 11, 2021

Organization subpart

No

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

Addresses

Other names 1

• UAB Medicine Sleep Center at One Nineteen Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Eastside P.E.T. Center, LLC

  dba UAB St. Vincent's East P.E.T. Center

  • Diagnostic Radiology Physician
  • Birmingham, AL
  • NPI 1619925070

  2860594090

  Same PAC ID

Member of 1

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

• Med South, Inc.

  • Oxygen Equipment & Supplies (DME)
  • Huntsville, AL
  • NPI 1528495843

  Member Of

  NPD member

Locations

Practitioners 3

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.

• Fazal Rahim, M.D.

  • Neurology Physician
  • Pell City, AL
  • NPI 1811097462
  Medicare reassignment
• Robert Desha Hines IV, M.D.

  • Body Imaging Physician
  • Birmingham, AL
  • NPI 1396900197
  NPD
• Justin James Dubreus, MD

  • Hospitalist Physician
  • Port Angeles, WA
  • NPI 1104320613
  NPD (past)

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1649855545",
    "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": "7191 CAHABA VALLEY RD",
            "address_2": "BLDG 2 STE 203",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352426448",
            "telephone_number": "205-236-9943",
            "fax_number": "205-236-9947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE P.E.T. CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-11",
        "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": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UAB Medicine Sleep Center at One Nineteen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William Riley Dyer, DMD
• Dylan Carson Nutrition LLC
• E Neal Irwin OD Inc
• E. a. Kivus, D.D.S., PC
• Eagle Pharmacy Inc
• Melisa Eatman
• Haley Kay Eckl, PT, DPT
• Allyn Claire Edmonson, DPT
• Eseosa Edokpayi
• Elizabeth Edwards

• Sleep Disorder Diagnostic Clinic/Center in Hoover, AL
• Providers in Hoover, AL by specialty
• Sleep Disorder Diagnostic Clinic/Center in Alabama

• 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.