Palm Imaging Institute, a Medical Corporation

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

28926 Issued in CA

Legal business name

PALM IMAGING INSTITUTE, A MEDICAL CORPORATION

Practice address

399 E 21St St
San Bernardino, CA 92404-4815

Phone

(909) 882-2266

Fax

(909) 881-7593

NPI assigned

Jul 18, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Tanie Donaldson, RN

Title

Office Manager

Phone

(909) 882-2266

Specialties & licenses 5

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524441600000",
    "number": "1063411460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044815",
            "telephone_number": "909-882-2266",
            "fax_number": "909-881-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 E 21ST ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044815",
            "telephone_number": "909-882-2266",
            "fax_number": "909-881-7593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 N Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923768071",
            "country_code": "US",
            "telephone_number": "909-421-3040",
            "fax_number": "909-421-3054",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 E Washington Street",
            "address_2": "Suie 200",
            "address_purpose": "LOCATION",
            "city": "Colton",
            "state": "CA",
            "postal_code": "923244192",
            "country_code": "US",
            "telephone_number": "909-882-5867",
            "fax_number": "909-503-1913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALM IMAGING INSTITUTE, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2018-04-23",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "TANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-882-2266",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "CA",
            "license": "G55682",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A84930",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "28926",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 10673",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA20947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0063970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Palacios Dental Corp
• Denice Palacios, ASW
• Lily Ana Palacios
• Marlen Palacios
• Alma M Palisoc, M.D.
• Palm Springs Anesthesia Services, PC
• Teuila Palm, AMFT
• Joseph Palmeira, BCBA
• Catherine Palmer, MSW, LCSW
• Gloria Palmer

• Diagnostic Radiology Physician in San Bernardino, CA
• Providers in San Bernardino, 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 Apr 23, 2018; 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.