NPIMap

Organization Active NPI

Riverside Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Riverside, CA
National Provider Identifier
1013092394
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RIVERSIDE RADIOLOGY MEDICAL GROUP INC
Practice address
4500 Brockton Ave
Suite 219
Riverside, CA 92501-4090
Phone
(951) 276-7550
Fax
(951) 276-9883
NPI assigned
Oct 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

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

Authorized official

Name
Donald R. Massee, M.D.NPI 1801897731
Title
Secretary
Phone
(951) 788-3400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

4500 Brockton Ave
Suite 219
Riverside, CA 92501-4090

Mailing address

PO Box 15648
Sacramento, CA 95852
Phone (951) 781-2270

Other identifiers 1

IdentifierTypeStateIssuer
GR0104280MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120509000724 CA Part B Supplier - Clinic/Group Practice 2365412327 Receives reassigned benefits from 36 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rancho Cucamonga, CA; Sacramento, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; San Clemente, CA; Temple City, CA; Torrance, CA…

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 5

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1013092394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15648",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95852",
            "telephone_number": "951-781-2270",
            "fax_number": "951-781-2293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 BROCKTON AVE",
            "address_2": "SUITE 219",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014090",
            "telephone_number": "951-276-7550",
            "fax_number": "951-276-9883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "MASSEE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "951-788-3400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0104280",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; 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.