St. Jude Radiology Medical Group, Inc.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

ST. JUDE RADIOLOGY MEDICAL GROUP, INC.

Practice address

2059 Stratford Ave
South Pasadena, CA 91030-4640

Phone

(714) 992-3978

NPI assigned

Jul 12, 2017

Organization subpart

No

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

Authorized official

Name

Bradley A. Jackson, MD

Title

Medical Director / Ceo

Phone

(714) 992-3978

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• St Jude Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1255819892

  O20040115000501

  Same enrollment
• St Jude Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1649349705

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1043732019

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Walnut Creek, CA
  • NPI 1750803722

  O20040115000501

  Same enrollment

Practitioners 1

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

• Matthew D. Benedict, M.D.

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1528008125
  NPD

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1043732001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 940",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913190940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2059 STRATFORD AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304640",
            "telephone_number": "714-992-3978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2311 4th St Apt 321",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904053459",
            "country_code": "US",
            "telephone_number": "714-992-3978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. JUDE RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR / CEO",
        "authorized_official_telephone_number": "714-992-3978",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Pasadena Rehabilitation Center, LLC
• Julissa Sparks, LPCC, NCC
• Daniel Fred Spector, PH.D.
• Vincent Frank Spero, DDS
• Catherine Spicer, LMFT
• Lisa Staab Shadburn, PSY.D.
• Symona Stans
• Natalia Olarte Staunton, LMFT AND PSY
• Stellar Steps LLC
• Craig Stephens

• Diagnostic Radiology Physician in South Pasadena, CA
• Providers in South Pasadena, 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 Mar 17, 2018; 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.