NPIMap

Organization Active NPI

Delta Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Lodi, CA
National Provider Identifier
1043229271
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DELTA RADIOLOGY MEDICAL GROUP, INC.
Practice address
1121 W Vine St
Suite 15
Lodi, CA 95240-5137
Phone
(209) 334-4416
Fax
(209) 371-0119
NPI assigned
Aug 5, 2006
Last updated
Dec 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

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

Authorized official

Name
Terry Goldberg
Title
Ceo
Phone
(209) 334-4416

Specialties & licenses 1

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

Addresses

Primary practice location

1121 W Vine St
Suite 15
Lodi, CA 95240-5137

Mailing address

PO Box 15498
Sacramento, CA 95851-0498
Phone (559) 455-4000

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ47020ZMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013000834 CA Part B Supplier - Clinic/Group Practice 5294795308 Receives reassigned benefits from 34 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Danville, CA; Stockton, CA; San Luis Obispo, CA; San Jose, CA; San Diego, CA; Sacramento, CA; Roseville, CA; Pleasanton, CA…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Delta Radiology Inc4 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.

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1043229271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15498",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958510498",
            "telephone_number": "559-455-4000",
            "fax_number": "559-455-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W VINE ST",
            "address_2": "SUITE 15",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405137",
            "telephone_number": "209-334-4416",
            "fax_number": "209-371-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-334-4416"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ47020Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; 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.