Individual provider Active NPI

John Randall Santa Cruz Jr., M.D.

  • Diagnostic Radiology Physician
  • Boston, MA
National Provider Identifier
1164087979
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1022651 Issued in MA
Practice address
75 Francis St
Boston, MA 02115-6106
Phone
(228) 216-9661
NPI assigned
May 7, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1022651 MA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

75 Francis St
Boston, MA 02115-6106

Mailing address

75 Francis St
Boston, MA 02115-6106

Other practice location 1

1 Baylor Plz
Houston, TX 77030-3411
Phone (228) 216-9661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250220001980 WA Practitioner - Diagnostic Radiology 8325568306 Reassigns benefits to 1 organization
I20250519001666 MA Practitioner - Diagnostic Radiology 8325568306 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Baylor College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1482 Tremont St
Apt W302
Boston, MA 02120-2956
Phone (253) 661-4755

533 S 336TH St
Suite C
Federal Way, WA 98003-6329
Phone (253) 661-1700

Hospital & facility affiliations

  • Valley Medical Center Hospital, Renton, WA, CCN 500088
  • Multicare Auburn Medical Center Hospital, Auburn, WA, CCN 500015
  • Multicare Covington Medical Center Hospital, Covington, WA, CCN 500154

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1022651MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vantage Radiology & Diagnostic Services, a Professional Services Corp Diagnostic Radiology CurrentSince Apr 1, 2025 Accepting new patients
Brigham & Womens Physicians Organization Inc CurrentSince Jun 1, 2025 Accepting new patients

Locations

75 Francis St
Boston, MA 02115

62 13th St
Charlestown, MA 02129
Phone (617) 724-4260

533 S 336th St
Ste C
Federal Way, WA 98003
Phone (253) 661-4755

400 S 43rd St
Renton, WA 98055
Phone (425) 228-3450

Organizations & group practices 2

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 4

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": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1164087979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156106",
            "telephone_number": "228-216-9661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "228-216-9661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTA CRUZ",
        "first_name": "JOHN",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-07",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1022651",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.