NPIMap

Organization Active NPI

Back Bay Medical LLC

  • Radiology Clinic/Center
  • Newport Beach, CA
National Provider Identifier
1073528469
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
TG158 Issued in CA
Legal business name
BACK BAY MEDICAL LLC
Practice address
20311 SW Acacia St
Suite 140
Newport Beach, CA 92660-1733
Phone
(949) 756-8200
Fax
(949) 203-8542
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

Name
Dr. Gregory A Robertson, MDNPI 1932281011
Title
Director
Phone
(949) 756-8200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X TG158 CA Primary

Addresses

Primary practice location

20311 SW Acacia St
Suite 140
Newport Beach, CA 92660-1733

Mailing address

20311 SW Acacia St
Suite 140
Newport Beach, CA 92660-1733
Phone (949) 756-8200

Other names 1

  • Advanced Body Scan of Newport Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1073528469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20311 SW ACACIA ST",
            "address_2": "SUITE 140",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601733",
            "telephone_number": "949-756-8200",
            "fax_number": "949-203-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20311 SW ACACIA ST",
            "address_2": "SUITE 140",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601733",
            "telephone_number": "949-756-8200",
            "fax_number": "949-203-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK BAY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "949-756-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": "TG158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Body Scan of Newport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; 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.