NPIMap

Organization Active NPI

St Marys Radiology Medical Group

  • Specialist
  • Long Beach, CA
National Provider Identifier
1043258676
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ST MARYS RADIOLOGY MEDICAL GROUP
Practice address
1045 Atlantic Ave
Suite 105
Long Beach, CA 90813-3408
Phone
(562) 437-3833
Fax
(562) 624-0741
NPI assigned
Jun 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Authorized official

Name
Dr. Gregory T Vanley, M.D.
Title
Partner
Phone
(562) 437-3833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1045 Atlantic Ave
Suite 105
Long Beach, CA 90813-3408

Mailing address

1045 Atlantic Ave
Suite 105
Long Beach, CA 90813-3408
Phone (562) 437-3833

Other identifiers 1

IdentifierTypeStateIssuer
GR0003580MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397001600000",
    "number": "1043258676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "SUITE 105",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133408",
            "telephone_number": "562-437-3833",
            "fax_number": "562-624-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "SUITE 105",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133408",
            "telephone_number": "562-437-3833",
            "fax_number": "562-624-0741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARYS RADIOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2014-04-09",
        "status": "A",
        "authorized_official_last_name": "VANLEY",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "562-437-3833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0003580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.