Gardena Radiology Medical Group

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

GARDENA RADIOLOGY MEDICAL GROUP

Practice address

1145 W Redondo Beach Blvd
Gardena, CA 90247-3511

Phone

(310) 836-1574

NPI assigned

Sep 5, 2007

Organization subpart

Yes

Parent organization

WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUPAs reported in NPPES

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

Authorized official

Name

Dr. John N. Loizeaux-Witte, M.D.

Title

Ceo

Phone

(310) 836-1574

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Western Imaging Center

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Western Diagnostic & Therapeutic Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Marina del Rey, CA
  • NPI 1700979390
  NPPES parent name

Practitioners 1

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

• Laura A Thompson, M.D.

  • Nuclear Radiology Physician
  • Marina del Rey, CA
  • NPI 1285789834
  NPD (past)

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1174717912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17959",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900170959",
            "telephone_number": "213-481-0584",
            "fax_number": "213-481-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 W REDONDO BEACH BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473511",
            "telephone_number": "310-836-1574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDENA RADIOLOGY MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP",
        "enumeration_date": "2007-09-05",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "LOIZEAUX-WITTE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-836-1574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017071",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gardena Hospital, L.P.
• Gardena Pharmacy Corporation
• Gardena Physical Therapy & Rehabilitation Center
• Gardena Physical Therapy Inc
• Gardena Physicians Hospital, Inc.
• Gardena Retirement
• Gardena Surgical Inc a Medical
• Wilma Gardner-Watson, BA DEGREE
• Garfield Beach CVS LLC
• Garfield Beach CVS LLC

• Diagnostic Radiology Physician in Gardena, CA
• Providers in Gardena, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.