NPIMap

Organization Active NPI

St Vincent Radiological Medical Group

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1083875884
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST VINCENT RADIOLOGICAL MEDICAL GROUP
Practice address
2131 W 3Rd St
Los Angeles, CA 90057-1901
Phone
(213) 484-7901
Fax
(213) 353-0325
NPI assigned
Jun 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

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

Authorized official

Name
Victor Waluch, M.D.
Title
Cfo
Phone
(213) 484-7901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2131 W 3Rd St
Los Angeles, CA 90057-1901

Mailing address

PO Box 19130
Newbury Park, CA 91319-9130
Phone (213) 484-7901

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ77454ZMedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1083875884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19130",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913199130",
            "telephone_number": "213-484-7901",
            "fax_number": "213-353-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 W 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571901",
            "telephone_number": "213-484-7901",
            "fax_number": "213-353-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT RADIOLOGICAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "WALUCH",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "213-484-7901",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ77454Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; 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.