NPIMap

Organization Active NPI

Radiology Medical Group of Santa Cruz County Inc

  • Diagnostic Radiology Physician
  • Freedom, CA
National Provider Identifier
1306854294
Registry record updated Mar 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
Practice address
108 B Green Valley Road
Freedom, CA 95019-3110
Phone
(831) 724-2236
Fax
(831) 724-8440
NPI assigned
Aug 4, 2006
Last updated
Mar 27, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2008

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

Authorized official

Name
Kenneth E Averill Jr., MD
Title
President
Phone
(831) 476-1542

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

108 B Green Valley Road
Freedom, CA 95019-3110

Mailing address

1661 Soquel Drive
Building G
Santa Cruz, CA 95065-1709
Phone (831) 476-1542

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ73806ZMedicaidCA
ZZZ73808ZOtherCABLUE SHIELD

Other names 1

  • South County Imaging Other name

National Provider Directory

National Provider Directory
Tax ID family
Radiology Medical GRP S6 organizations share this tax ID, including this one
Part of
Radiology Medical GRP S

Other organizations with this tax ID 5

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

Locations

108 Green Valley Rd
#B
Freedom, CA 95019
Phone (831) 268-4340

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1306854294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 SOQUEL DRIVE",
            "address_2": "BUILDING G",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651709",
            "telephone_number": "831-476-1542",
            "fax_number": "831-464-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 B GREEN VALLEY ROAD",
            "city": "FREEDOM",
            "state": "CA",
            "postal_code": "950193110",
            "telephone_number": "831-724-2236",
            "fax_number": "831-724-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "AVERILL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "831-476-1542",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73806Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ73808Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South County Imaging",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Freedom, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.