NPIMap

Organization Active NPI

San Diego Diagnostic Radiology Medical Group, Inc.

  • Radiology Clinic/Center
  • Poway, CA
National Provider Identifier
1295088334
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
SAN DIEGO DIAGNOSTIC RADIOLOGY MEDICAL GROUP, INC.
Practice address
15525 Pomerado Rd
Suite E2
Poway, CA 92064-2435
Phone
(858) 521-0031
NPI assigned
Oct 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Norman C. Chen, MD
Title
President/Ceo
Phone
(858) 565-0950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

15525 Pomerado Rd
Suite E2
Poway, CA 92064-2435

Mailing address

PO Box 23540
San Diego, CA 92193-3540
Phone (858) 565-0950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000793 CA Part B Supplier - Clinic/Group Practice 0143134353 Receives reassigned benefits from 72 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; Solana Beach, CA; Chula Vista, CA; Coronado, CA; Del Mar, CA; Encinitas, CA; La Jolla, CA; Laguna Niguel, CA…

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1295088334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23540",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921933540",
            "telephone_number": "858-565-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE E2",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "858-521-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO DIAGNOSTIC RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "858-565-0950",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poway, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.