Tallahassee Diagnostic Imaging LTD – Diagnostic Radiology Physician, NPI 1639129521
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Tallahassee Diagnostic Imaging LTD
PO BOX 21348
TAMPA, FL 336221348
Phone: (850) 878-4127
Fax: (850) 942-4155
Type: Mailing
1600, Phillips Road, Tallahassee, Leon County, Florida, 32308, United States
TALLAHASSEE, FL 323085304
Phone: (850) 878-4127
Fax: (850) 878-9729
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-01-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-12-31 (892 days ago).
Enrollment records
20
Earliest due date
2023-12-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040615001595 | O | Clinic/Group Practice | FL | TBD |
| O20161206000637 | O | Clinic/Group Practice | TX | 2023-12-31 |
| O20170525000783 | O | Clinic/Group Practice | NY | TBD |
| O20190222001138 | O | Clinic/Group Practice | OK | 2024-05-31 |
| O20191111001081 | O | Clinic/Group Practice | CO | 2025-08-31 |
| O20210111000945 | O | Clinic/Group Practice | WV | 2026-01-31 |
| O20210119000171 | O | Clinic/Group Practice | AZ | 2026-10-31 |
| O20210126003373 | O | Clinic/Group Practice | NE | TBD |
| O20210212001319 | O | Clinic/Group Practice | MA | TBD |
| O20210407002646 | O | Clinic/Group Practice | DC | TBD |
| O20210408002761 | O | Clinic/Group Practice | WA | TBD |
| O20210525002642 | O | Clinic/Group Practice | MI | TBD |
| O20210630002367 | O | Clinic/Group Practice | ND | TBD |
| O20211215002807 | O | Clinic/Group Practice | MD | TBD |
| O20211222001034 | O | Clinic/Group Practice | AK | TBD |
| O20230822000587 | O | Clinic/Group Practice | UT | TBD |
| O20240109001969 | O | Clinic/Group Practice | GA | TBD |
| O20240221000258 | O | Clinic/Group Practice | NC | TBD |
| O20250114000472 | O | Clinic/Group Practice | TN | TBD |
| O20250123002627 | O | Clinic/Group Practice | AL | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33622)
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