NPIMap

Organization Active NPI

California Diagnostic Imaging Center a Medical Corporation

  • Diagnostic Radiology Physician
  • Glendora, CA
National Provider Identifier
1396737474
Registry record updated Oct 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CALIFORNIA DIAGNOSTIC IMAGING CENTER A MEDICAL CORPORATION
Practice address
828 S Grand Ave
Ste 104
Glendora, CA 91740-4856
Phone
(626) 915-5181
Fax
(626) 331-2313
NPI assigned
Aug 16, 2005
Last updated
Oct 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2017

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

Authorized official

Name
David J Underwood, MDNPI 1023080686
Title
President
Phone
(626) 339-5464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

828 S Grand Ave
Ste 104
Glendora, CA 91740-4856

Mailing address

Box 5010
Glendora, CA 91740-0735
Phone (626) 915-5181

Other identifiers 3

IdentifierTypeStateIssuer
GR0103720MedicaidCA
P00081546OtherCARAIL ROAD MEDICARE GRP #
ZZZ07258ZOtherCABLUE SHIELD

National Provider Directory

National Provider Directory

Locations

828 S Grand Ave
Glendora, CA 91740
Phone (626) 963-2057

Practitioners & affiliated clinicians

Practitioners 5

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": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1396737474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 5010",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917400735",
            "telephone_number": "626-915-5181",
            "fax_number": "626-331-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 S GRAND AVE",
            "address_2": "STE 104",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404856",
            "telephone_number": "626-915-5181",
            "fax_number": "626-331-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA DIAGNOSTIC IMAGING CENTER A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-339-5464",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0103720",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE GRP #",
            "identifier": "P00081546",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07258Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; 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.