Pegasus Diagnostics Inc

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

PEGASUS DIAGNOSTICS INC

Practice address

29230 Ryan Rd Ste C-1
Warren, MI 48092-4274

Phone

(313) 312-3932

NPI assigned

Nov 27, 2017

Organization subpart

No

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

Authorized official

Name

Tufiqul Islam

Title

President/Ceo

Phone

(313) 312-3932

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Portable X-ray supplier certification: CCN 23X0009842

Legal name

PEGASUS DIAGNOSTICS

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Dec 16, 2021

Last certification

Dec 16, 2021

Ownership / control type

Corporation

Facility address

29230 Ryan Rd, Suite C-1
Warren, MI 48092

Other NPIs with the same Medicare PAC ID 1

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

• Pegasus Diagnostics Inc

  • Physiological Laboratory
  • Sterling Heights, MI
  • NPI 1730693821

  5799044384

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pegasus Diagnostics Inc

  • Physiological Laboratory
  • Sterling Heights, MI
  • NPI 1730693821

  O20210513002108

  Same enrollment

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

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656892800000",
    "number": "1790299964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29230 RYAN RD STE C-1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924274",
            "telephone_number": "313-312-3932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29230 RYAN RD STE C-1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924274",
            "telephone_number": "313-312-3932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3686 Brandi Dr",
            "address_purpose": "LOCATION",
            "city": "Sterling Heights",
            "state": "MI",
            "postal_code": "483102538",
            "country_code": "US",
            "telephone_number": "313-312-3932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEGASUS DIAGNOSTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-27",
        "last_updated": "2022-07-04",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "ISLAM",
        "authorized_official_first_name": "TUFIQUL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "313-312-3932"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Warren, MI
• Providers in Warren, MI by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.