NPIMap

Organization Active NPI

Radiology Medical Medical Group

  • Specialist
  • Stockton, CA
National Provider Identifier
1255413811
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
RADIOLOGY MEDICAL MEDICAL GROUP
Practice address
1617 N California St
Ste 1a
Stockton, CA 95204-6117
Phone
(209) 334-7810
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Terry Goldberg
Title
Ceo
Phone
(209) 334-7810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1617 N California St
Ste 1a
Stockton, CA 95204-6117

Mailing address

PO Box 15498
Sacramento, CA 95851-0498
Phone (209) 334-7810

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ00340ZOtherCABLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Delta Radiology Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255413811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15498",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958510498",
            "telephone_number": "209-334-7810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 N CALIFORNIA ST",
            "address_2": "STE 1A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046117",
            "telephone_number": "209-334-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY MEDICAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-334-7810",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ00340Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.