NPIMap

Organization Active NPI

South Carolina Diagnostic Imaging, LLC

Doing business as Tricom Diagnostic Imaging

  • Diagnostic Radiology Physician
  • N Charleston, SC
National Provider Identifier
1952369266
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SOUTH CAROLINA DIAGNOSTIC IMAGING, LLC
Doing business as
Tricom Diagnostic Imaging
Practice address
2851 Tricom Blvd
N Charleston, SC 29406-9172
Phone
(770) 300-0101
Fax
(770) 300-0429
NPI assigned
May 3, 2006
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Mr. Geoffrey K. Gardner
Title
SVP Finance and Revenue Cycle
Phone
(336) 718-2078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X SC Primary

Addresses

Primary practice location

2851 Tricom Blvd
N Charleston, SC 29406-9172

Mailing address

PO Box 933548
Atlanta, GA 31193-3548
Phone (770) 300-0101

Other identifiers 1

IdentifierTypeStateIssuer
470001385OtherSCRAILROAD MEDICARE

Other names 1

  • Tricom Diagnostic Imaging Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120327000862 SC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 5597663674 Practice locations: North Charleston, SC

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
South Carolina Diagnostic Imaging LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1952369266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933548",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311933548",
            "telephone_number": "770-300-0101",
            "fax_number": "770-300-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 TRICOM BLVD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "770-300-0101",
            "fax_number": "770-300-0429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA DIAGNOSTIC IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "SVP FINANCE AND REVENUE CYCLE",
        "authorized_official_telephone_number": "336-718-2078",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "470001385",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tricom Diagnostic Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tricom Diagnostic Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in N Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.