Russell Dickerson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G32003 Issued in CA

Practice address

3330 Lomita Blvd
Torrance, CA 90505-5002

Phone

(310) 517-4675

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

University of Southern California Keck School of Medicine, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Torrance Health Association IncGroup PAC ID 1355302134, 298 clinicians

Torrance Radiology Medical GroupGroup PAC ID 5496764755, 19 clinicians

Torrance Memorial Medical CenterGroup PAC ID 9638087703, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Torrance Health Association Inc

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1083903124
  Medicare reassignment Care Compare group NPD
• Torrance Memorial Medical Center

  • Diagnostic Radiology Physician
  • Torrance, CA
  • NPI 1477502797
  Medicare reassignment Care Compare group NPD
• Torrance Radiology Medical Group

  • Diagnostic Radiology Physician
  • Torrance, CA
  • NPI 1457394264
  Medicare reassignment Care Compare group NPD
• Torrance Memorial Medical Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1740268713
  NPD
• Brotman Medical Center, Inc.

  • Skilled Nursing Facility
  • Culver City, CA
  • NPI 1518997733
  NPD (past)
• Gardena Hospital LP

  • Institutional Pharmacy
  • Gardena, CA
  • NPI 1669491700
  NPD (past)
• Southern California Healthcare System, Inc

  • Psychiatric Hospital Unit
  • Culver City, CA
  • NPI 1487905725
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Torrance Memorial Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1467459776
  Care Compare affiliation

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443139200000",
    "number": "1023062320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930620190",
            "telephone_number": "805-522-5940",
            "fax_number": "805-522-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 LOMITA BLVD",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055002",
            "telephone_number": "310-517-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2015-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G32003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luis Alejandro Diaz Sr.
• Natalie Diaz, M.D.
• Roxanne Diaz
• Taylor Diaz, PA-C
• Alessandra Dibernardo, PTA
• Vanessa Lynn Dickey, MD
• Natalie Jeanette Dicks, BA, MA
• Domenic Didomenicantonio, DC
• Kimberly Didomenicantonio, DC
• Leilani Fang Diego

• Diagnostic Radiology Physician in Torrance, CA
• Providers in Torrance, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.