NPIMap

Organization Active NPI

I V Radiology Medical Group

  • Diagnostic Radiology Physician
  • San Mateo, CA
National Provider Identifier
1255856183
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
I V RADIOLOGY MEDICAL GROUP
Practice address
728 Murphy Dr
San Mateo, CA 94402-3421
Phone
(559) 455-4127
NPI assigned
Aug 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Authorized official

Name
Dr. John Hadorn
Title
Authorized Signer
Phone
(559) 455-4127

Specialties & licenses 1

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

Addresses

Primary practice location

728 Murphy Dr
San Mateo, CA 94402-3421

Mailing address

PO Box 9
Newbury Park, CA 91319-0009

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000493 CA Part B Supplier - Clinic/Group Practice 7517952310 Receives reassigned benefits from 45 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Truckee, CA; San Luis Obispo, CA; San Francisco, CA; San Diego, CA; Sacramento, CA; Roseville, CA; Playa Vista, CA; Mission Viejo, CA…

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1255856183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913190009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 MURPHY DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023421",
            "telephone_number": "559-455-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I V RADIOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A",
        "authorized_official_last_name": "HADORN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "AUTHORIZED SIGNER",
        "authorized_official_telephone_number": "559-455-4127",
        "authorized_official_name_prefix": "Dr."
    },
    "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 Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.