St Jude Radiology Medical Group Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

ST JUDE RADIOLOGY MEDICAL GROUP INC

Practice address

101 E Valencia Mesa Dr
Fullerton, CA 92835-3809

Phone

(714) 992-3000

Fax

(916) 533-0313

NPI assigned

Aug 6, 2018

Organization subpart

No

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

Authorized official

Name

Bradley A. Jackson, MD

Title

Ceo

Phone

(559) 455-4109

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• St Jude Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1649349705

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • South Pasadena, CA
  • NPI 1043732001

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1043732019

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Walnut Creek, CA
  • NPI 1750803722

  O20040115000501

  Same enrollment

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1255819892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26570",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296570",
            "telephone_number": "714-992-3978",
            "fax_number": "714-446-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-992-3000",
            "fax_number": "916-533-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-06",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-455-4109",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Jude Hospital Yorba Linda
• St Jude Hospital Yorba Linda
• St Jude Hospital Yorba Linda
• St Jude Hospital Yorba Linda
• St Jude Hospital Yorba Linda
• St Jude Radiology Medical Group Inc
• St Jude Radiology Medical GRP, Inc
• St, Jude Heritage Medical Group
• St. Elizabeth Healthcare and Rehabilitation Center, LLC
• St. Jude Hospital, Inc.

• Diagnostic Radiology Physician in Fullerton, CA
• Providers in Fullerton, 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 Feb 12, 2021; 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.