NPIMap

Organization Active NPI

Modesto Radiological Medical Group, Inc

  • Diagnostic Radiology Physician
  • Tracy, CA
National Provider Identifier
1134670656
Registry record updated Jan 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MODESTO RADIOLOGICAL MEDICAL GROUP, INC
Practice address
8673 Julie Lynne Cir
Tracy, CA 95304-9207
Phone
(209) 342-5946
NPI assigned
Oct 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2017

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

Authorized official

Name
Mark E Moore
Title
Coo
Phone
(209) 342-5946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

8673 Julie Lynne Cir
Tracy, CA 95304-9207

Mailing address

PO Box 7326
San Francisco, CA 94120-7326
Phone (559) 455-4009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040513000453 CA Part B Supplier - Clinic/Group Practice 2062300239 Receives reassigned benefits from 104 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20240429000817 NM Part B Supplier - Clinic/Group Practice 2062300239 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Modesto Radiological Medical Group Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483660800000",
    "number": "1134670656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7326",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941207326",
            "telephone_number": "559-455-4009",
            "fax_number": "916-533-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8673 JULIE LYNNE CIR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953049207",
            "telephone_number": "209-342-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO RADIOLOGICAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2017-01-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "209-342-5946"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; 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.