NPIMap

Organization Active NPI

Magnolia Medical Imaging Center Inc a Medical Group

  • Radiology Clinic/Center
  • Westminster, CA
National Provider Identifier
1376685446
Registry record updated Dec 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
050920 Issued in CA
Legal business name
MAGNOLIA MEDICAL IMAGING CENTER INC A MEDICAL GROUP
Practice address
14571 Magnolia St Ste 101
Westminster, CA 92683-5575
Phone
(714) 893-1915
Fax
(714) 898-8142
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2015

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

Authorized official

Name
Thanh G Phung, MDNPI 1952315319
Title
President
Phone
(714) 893-1915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 050920 CA Primary

Addresses

Primary practice location

14571 Magnolia St Ste 101
Westminster, CA 92683-5575

Mailing address

14571 Magnolia St Ste 101
Westminster, CA 92683-5575
Phone (714) 893-1915

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507001355 CA Part B Supplier - Clinic/Group Practice 7719976414 Receives reassigned benefits from 3 practitioners
Practice locations: Westminster, CA

National Provider Directory

National Provider Directory

Locations

335 E Foothill Blvd
Pomona, CA 91767
Phone (909) 593-1111

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1376685446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14571 MAGNOLIA ST STE 101",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835575",
            "telephone_number": "714-893-1915",
            "fax_number": "714-898-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14571 MAGNOLIA ST STE 101",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835575",
            "telephone_number": "714-893-1915",
            "fax_number": "714-898-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL IMAGING CENTER INC A MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "PHUNG",
        "authorized_official_first_name": "THANH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-893-1915",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": "050920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.