NPIMap

Organization Active NPI

Tower Imaging Medical Group, Inc

  • Diagnostic Radiology Physician
  • Santa Monica, CA
National Provider Identifier
1013962067
Registry record updated Feb 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
TOWER IMAGING MEDICAL GROUP, INC
Practice address
2202 Wilshire Blvd
Santa Monica, CA 90403-5706
Phone
(310) 264-9000
Fax
(310) 264-9004
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2009

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

Authorized official

Name
Gerald M. Roth, M.D.
Title
President
Phone
(323) 549-3030

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0904X
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2202 Wilshire Blvd
Santa Monica, CA 90403-5706

Mailing address

Dept la 21559
Pasadena, CA 91185-1559
Phone (888) 727-1073

Other identifiers 10

IdentifierTypeStateIssuer
GR0056083MedicaidCA
ZZZ05808ZOtherCABLUE SHIELD
GR0056081MedicaidCA
ZZZ09295ZOtherCABLUE SHIELD
ZZZ64302ZOtherCABLUE SHIELD
GR0056084MedicaidCA
GR0056086MedicaidCA
ZZZ59119ZOtherCABLUE SHIELD
GR0056085MedicaidCA
ZZZ07585ZOtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120001020 CA Part B Supplier - Clinic/Group Practice 2668376708 Receives reassigned benefits from 42 practitioners
Practice locations: Redondo Beach, CA; Valencia, CA; Santa Monica, CA; South Pasadena, CA; Studio City, CA; Thousand Oaks, CA; Pacific Palisades, CA; Calabasas, CA…
O20260323002102 NY Part B Supplier - Clinic/Group Practice 2668376708 Receives reassigned benefits from 1 practitioner
Practice locations: Scarsdale, NY

National Provider Directory

National Provider Directory

Locations

Dept LA 21559
Pasadena, CA 91185

2200 Wilshire Blvd
Santa Monica, CA 90403
Phone (310) 264-9000

23929 McBean Pkwy
Valencia, CA 91355
Phone (661) 253-8705

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 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234137600000",
    "number": "1013962067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT LA 21559",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911851559",
            "telephone_number": "888-727-1073",
            "fax_number": "866-752-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 WILSHIRE BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035706",
            "telephone_number": "310-264-9000",
            "fax_number": "310-264-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWER IMAGING MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2009-02-09",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-549-3030",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056083",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ05808Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056081",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ09295Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ64302Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056084",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056086",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ59119Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056085",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07585Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; 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.