NPIMap

Organization Active NPI

Online Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • San Clemente, CA
National Provider Identifier
1235535220
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G81806 Issued in CA
Legal business name
ONLINE RADIOLOGY MEDICAL GROUP, INC.
Practice address
315 Calle Pescador
San Clemente, CA 92672-2206
Phone
(949) 388-4014
NPI assigned
Nov 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Authorized official

Name
Samuel Salen
Title
M.D., Cfo
Phone
(951) 786-0801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X G81806 CA Primary

Addresses

Primary practice location

315 Calle Pescador
San Clemente, CA 92672-2206

Mailing address

75 Remittance Dr
Dept. 6620
Chicago, IL 60675-6620
Phone (888) 412-2639

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100113000708 CA Part B Supplier - Clinic/Group Practice 0648311548 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Malibu, CA; Manhattan Beach, CA; Marina del Rey, CA; Mill Valley, CA; Murietta, CA; Newport Beach, CA; Newport Coast, CA; Oceanside, CA…

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
Tax ID family
On-Line Radiology Medical Group Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1235535220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 REMITTANCE DR",
            "address_2": "DEPT. 6620",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606756620",
            "telephone_number": "888-412-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 CALLE PESCADOR",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926722206",
            "telephone_number": "949-388-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONLINE RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-18",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "SALEN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "M.D., CFO",
        "authorized_official_telephone_number": "951-786-0801"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G81806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; 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.