Active NPI
Delta Radiology Medical Group, Inc.
- Specialist
- San Francisco, CA
National Provider Identifier
1366567463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- DELTA RADIOLOGY MEDICAL GROUP, INC.
- Practice address
- 845 Jackson St
San Francisco, CA 94133-4851 - Phone
- (415) 677-2325
- Fax
- (415) 677-2444
- NPI assigned
- Mar 20, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Terry Goldberg
- Title
- Ceo
- Phone
- (209) 334-4416
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
845 Jackson St
San Francisco, CA 94133-4851
Mailing address
PO Box 15498
Sacramento, CA 95851-0498
Phone (559) 455-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0006150 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041013000834 | CA | Part B Supplier - Clinic/Group Practice | 5294795308 |
Receives reassigned benefits from 34 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Danville, CA; Stockton, CA; San Luis Obispo, CA; San Jose, CA; San Diego, CA; Sacramento, CA; Roseville, CA; Pleasanton, CA… |
Other NPIs on the same Medicare enrollment 8
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Diagnostic Radiology Physician
- Stockton, CA
- NPI 1639499239
O20041013000834
-
- Diagnostic Radiology Physician
- Lodi, CA
- NPI 1043229271
O20041013000834
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1197331200000",
"number": "1366567463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15498",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958510498",
"telephone_number": "559-455-4000",
"fax_number": "559-455-4007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 JACKSON ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941334851",
"telephone_number": "415-677-2325",
"fax_number": "415-677-2444"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DELTA RADIOLOGY MEDICAL GROUP, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-20",
"last_updated": "2007-12-11",
"status": "A",
"authorized_official_last_name": "GOLDBERG",
"authorized_official_first_name": "TERRY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "209-334-4416"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0006150",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; 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.