NPIMap

Organization Active NPI

Medical Insights Diagnostic Centers Concord Professional Corporation

  • Diagnostic Radiology Physician
  • San Leandro, CA
National Provider Identifier
1205990389
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MEDICAL INSIGHTS DIAGNOSTIC CENTERS CONCORD PROFESSIONAL CORPORATION
Practice address
2800 Benedict Dr
San Leandro, CA 94577-6840
Phone
(510) 357-8300
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Authorized official

Name
Virgil Williams, MDNPI 1912941469
Title
Managing Physician
Phone
(510) 507-8528

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

2800 Benedict Dr
San Leandro, CA 94577-6840

Mailing address

PO Box 296
Landisville, PA 17538-0296
Phone (510) 357-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070319000143 CA Part B Supplier - Clinic/Group Practice 3678676350 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
Practice locations: Berkeley, CA; Escondido, CA; Palm Desert, CA; San Leandro, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Medical Insights Diagnostic Centers Concord Professional Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

223 Fargo Way
Folsom, CA 95630
Phone (916) 351-8848

Practitioners & affiliated clinicians

Practitioners 7

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571616000000",
    "number": "1205990389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "LANDISVILLE",
            "state": "PA",
            "postal_code": "175380296",
            "telephone_number": "510-357-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 BENEDICT DR",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945776840",
            "telephone_number": "510-357-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL INSIGHTS DIAGNOSTIC CENTERS CONCORD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2019-10-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "510-507-8528",
        "authorized_official_credential": "MD"
    },
    "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 San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.