Vine Imaging Partners Medical Group, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

VINE IMAGING PARTNERS MEDICAL GROUP, INC.

Practice address

1031 S Fairmont Ave
Lodi, CA 95240-5112

Phone

(209) 334-8580

NPI assigned

May 17, 2021

Organization subpart

No

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

Authorized official

Name

Grant William Rogero

Title

President

Phone

(209) 339-7476

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621209600000",
    "number": "1245804020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405112",
            "telephone_number": "209-334-8580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "975 S Fairmont Ave",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952405118",
            "country_code": "US",
            "telephone_number": "209-334-3411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VINE IMAGING PARTNERS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-17",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A",
        "authorized_official_last_name": "ROGERO",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-339-7476"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lodi, CA
• Providers in Lodi, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; 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.