Beverly Radiology Medical Group
Organization Active NPI Diagnostic Radiology Physician · Fallbrook, CA
NPI 1043681752 · NPPES record last updated Oct 8, 2015
Key facts
- NPI
- 1043681752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- BEVERLY RADIOLOGY MEDICAL GROUP
- Practice address
- 521 E Elder St
Suite 101
Fallbrook, CA 92028-3081 - Phone
- (310) 445-2000
- NPI assigned
- Oct 8, 2015
- Organization subpart
- No
Authorized official
- Name
- Howard G. Berger, M.D.
- Title
- President & Ceo
- Phone
- (310) 445-2000
Other NPIs on the same Medicare enrollment 9
Practitioners 11
-
Khadija Aziz, M.D
-
Kenneth W Chin, MD
-
Glenn Isamu Hananouchi, M.D.
-
Christopher Hsu, M.D.
-
Jason C Kantor, MD
-
Magie M. Malaro, MD
-
Russell Scott Montgomery, M.D.
-
Luis A. Solivan, MD
-
Douglas B. Tait, MD
-
Paul Tung, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000784 | CA | Part B Supplier - Clinic/Group Practice | 3476466376 |
Receives reassigned benefits from 343 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
521 E Elder St
Ste 101
Fallbrook, CA 92028
Phone (310) 445-2843
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
521 E Elder St
Suite 101
Fallbrook, CA 92028-3081
Mailing address
521 E Elder St
Suite 101
Fallbrook, CA 92028-3081
Phone (310) 445-2000
Other names
- Temecula Valley Imaging Center
Other providers in Fallbrook, CA
- Cheridan Bartkoski
- Be Well Family Health Care, Inc.
- Grace Beougher
- Alvaro Berrios
- Jackie Bestmann
- Nicholas Beye
- Randi Sue Beye
- Bianchi OB GYN Associates a Medical Corporation
- Ligia I Blanco- Spaeth
- Robert William Bolinger
All providers in Fallbrook, CA · Diagnostic Radiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.