NPIMap

Individual provider Active NPI

Johnson Benjamin Lightfoote, M.D.

  • Diagnostic Radiology Physician
  • Pomona, CA
National Provider Identifier
1083696637
Registry record updated Jun 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G39456 Issued in CA
Practice address
1798 N Garey Ave
Pomona, CA 91767
Phone
(909) 865-9535
Fax
(909) 630-7394
NPI assigned
Nov 18, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X G39456 CA
Diagnostic Radiology Physician 2085R0202X G39456 CA Primary

Addresses

Primary practice location

1798 N Garey Ave
Pomona, CA 91767

Mailing address

808 S Easthills Dr
West Covina, CA 91791-3449
Phone (909) 865-9535

Other identifiers 4

IdentifierTypeStateIssuer
ME 90724OtherFLSTATE MEDICAL LICENSE
200500078OtherNCSTATE MEDICAL LICENSE
G39456OtherCASTATE MEDICAL LICENSE
AL 8043OtherALSTATE MEDICAL LICENSE

Other names 1

  • Dr. Johnson Benjamin Lightfoote Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060421000557 CA Practitioner - Diagnostic Radiology 5496765349 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Harvard Medical School, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pomona Valley Imaging Medical Group IncGroup PAC ID 6709898562, 22 clinicians

Practice addresses (Care Compare)

1798 N Garey Ave
Pomona, CA 91767-2918
Phone (909) 865-9535

Hospital & facility affiliations

  • Pomona Valley Hospital Medical Center Hospital, Pomona, CA, CCN 050231
  • Casa Colina Hospital Hospital, Pomona, CA, CCN 050782
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099
  • Chino Valley Medical Center Hospital, Chino, CA, CCN 050586
  • L a Downtown Medical Center Hospital, Los Angeles, CA, CCN 050763

Merit-based Incentive Payment System (MIPS)

Final score
84.08 of 100Reported as group
Quality
81.28
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Desert Radiology Medical Group, Inc Diagnostic Radiology CurrentSince Jun 29, 2023 Accepting new patients
Pomona Valley Imaging Medical Group Inc CurrentSince Feb 16, 2006 Accepting new patients
Pomona Valley Imaging Group Diagnostic Radiology Current Accepting new patients
The Regents of the University of California Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Memrad Medical Group Inc Past Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
Usc Radiology Associates, Inc Neuroradiology Past Accepting new patients

Locations

1798 N Garey Ave
Pomona, CA 91767
Phone (909) 865-9810

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307750400000",
    "number": "1083696637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 S EASTHILLS DR",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917913449",
            "telephone_number": "909-865-9535",
            "fax_number": "909-630-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1798 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91767",
            "telephone_number": "909-865-9535",
            "fax_number": "909-630-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHTFOOTE",
        "first_name": "JOHNSON",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2011-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "CA",
            "license": "G39456",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G39456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "ME 90724",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "200500078",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "G39456",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "AL 8043",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHNSON",
            "last_name": "LIGHTFOOTE",
            "middle_name": "BENJAMIN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.