NPIMap

Organization Active NPI

Biopsy Diagnostics, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Ridgeland, SC
National Provider Identifier
1689652216
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
BIOPSY DIAGNOSTICS, LLC
Practice address
122 Riverwalk Blvd
Suite a
Ridgeland, SC 29936
Phone
(843) 379-2939
Fax
(843) 379-2949
NPI assigned
Jan 4, 2006
Last updated
May 23, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
AURORA DIAGNOSTICS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Authorized official

Name
Dina Valladares
Title
Director, Credentialing and Pe
Phone
(561) 514-5822

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary
Clinical Medical Laboratory 291U00000X 14814 SC
Clinical Medical Laboratory 291U00000X 052853 GA
Clinical Medical Laboratory 291U00000X 00024917 AL
Clinical Medical Laboratory 291U00000X 33767 NC
Clinical Medical Laboratory 291U00000X PFI8422 NY

Addresses

Primary practice location

122 Riverwalk Blvd
Suite a
Ridgeland, SC 29936

Mailing address

11025 Rca Center Drive
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 626-5512

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031231000684 SC Part B Supplier - Independent Clinical Laboratory 0749189447 Practice locations: Ridgeland, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1008880Biopsy Diagnostics, LLC122 Riverwalk Blvd,, Ridgeland, SC 29936AccreditationSep 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Biopsy Diagnostics PC5 organizations share this tax ID, including this one
Part of
Aurora Diagnostics LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

122 Riverwalk Blvd
Ste A
Ridgeland, SC 29936
Phone (843) 379-2939

122 Riverwalk Blvd
Ste A12
Ridgeland, SC 29936

Practitioners & affiliated clinicians

Practitioners 11

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": "1136332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1689652216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-626-5512",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 RIVERWALK BLVD",
            "address_2": "SUITE A",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "29936",
            "telephone_number": "843-379-2939",
            "fax_number": "843-379-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIOPSY DIAGNOSTICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AURORA DIAGNOSTICS, LLC",
        "enumeration_date": "2006-01-04",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "VALLADARES",
        "authorized_official_first_name": "DINA",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING AND PE",
        "authorized_official_telephone_number": "561-514-5822"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SC",
            "license": "14814",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "052853",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "00024917",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "33767",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "PFI8422",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.