NPIMap

Organization Active NPI

Kennewick Radiology Group, PC

  • Diagnostic Radiology Physician
  • Kennewick, WA
National Provider Identifier
1124592480
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
KENNEWICK RADIOLOGY GROUP, PC
Practice address
3810 Plaza Way
Kennewick, WA 99338-2722
Phone
(509) 585-5532
NPI assigned
Jan 18, 2019
Last updated
Jul 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Authorized official

Name
Sandip Patidar, MD
Title
Owner
Phone
(509) 392-5037

Specialties & licenses 1

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

Addresses

Primary practice location

3810 Plaza Way
Kennewick, WA 99338-2722

Mailing address

PO Box 6800
Portland, OR 97228-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190314000693 CA Part B Supplier - Clinic/Group Practice 9335230549 Receives reassigned benefits from 8 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Truckee, CA; Irvine, CA; San Luis Obispo, CA; San Diego, CA; Pasadena, CA; Newport Coast, CA; Roseville, CA
O20190319000921 TX Part B Supplier - Clinic/Group Practice 9335230549 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plano, TX; Spring, TX; San Antonio, TX; Lumberton, TX; Houston, TX; Dallas, TX; Austin, TX

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1124592480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6800",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972286800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 PLAZA WAY",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993382722",
            "telephone_number": "509-585-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEWICK RADIOLOGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "PATIDAR",
        "authorized_official_first_name": "SANDIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-392-5037",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.