NPIMap

Organization Active NPI

Glendale Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Glendale, CA
National Provider Identifier
1396759726
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GLENDALE RADIOLOGY MEDICAL GROUP, INC.
Practice address
1509 Wilson Ter
1420 S Central Ave
Glendale, CA 91206-4007
Phone
(818) 247-2095
Fax
(818) 247-1863
NPI assigned
Jul 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James M. Lilley, M.D.
Title
President
Phone
(818) 247-2095

Specialties & licenses 1

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

Addresses

Primary practice location

1509 Wilson Ter
1420 S Central Ave
Glendale, CA 91206-4007

Mailing address

625 N Maryland Ave
Glendale, CA 91206-2245
Phone (818) 247-2095

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ75635ZMedicaidCA

National Provider Directory

National Provider Directory

Locations

1509 Wilson Ter
#1420S
Glendale, CA 91206
Phone (818) 247-2095

625 N Maryland Ave
Glendale, CA 91206

Practitioners & affiliated clinicians

Practitioners 10

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": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396759726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 N MARYLAND AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912062245",
            "telephone_number": "818-247-2095",
            "fax_number": "818-247-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 WILSON TER",
            "address_2": "1420 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064007",
            "telephone_number": "818-247-2095",
            "fax_number": "818-247-1863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LILLEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-247-2095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "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": "ZZZ75635Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.