Advanced Imaging of Tracy LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

69105 Issued in CA

Legal business name

ADVANCED IMAGING OF TRACY LLC

Practice address

1530 Bessie Ave
Suite 108
Tracy, CA 95376-3080

Phone

(209) 342-2300

Fax

(209) 524-4240

NPI assigned

Oct 24, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Terri L Rondowanski

Title

Credentialing Specialist

Phone

(209) 342-2300

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275523151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 NORTHSTAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 BESSIE AVE",
            "address_2": "SUITE 108",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763080",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED IMAGING OF TRACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RONDOWANSKI",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "209-342-2300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "69105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07670Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.