Individual provider Active NPI

Stephen I. Moreland III, M.D.

  • Diagnostic Radiology Physician
  • San Diego, CA
National Provider Identifier
1447201603
Registry record updated Mar 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G55089 Issued in CA
Practice address
10150 Sorrento Valley Rd
Suite 320
San Diego, CA 92121-1635
Phone
(858) 454-4235
Fax
(858) 454-4644
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X G55089 CA Primary

Addresses

Primary practice location

10150 Sorrento Valley Rd
Suite 320
San Diego, CA 92121-1635

Mailing address

Dept la 21632
Pasadena, CA 91185-1632
Phone (858) 564-1400

Other identifiers 2

IdentifierTypeStateIssuer
00G550890MedicaidCA
00G550890OtherCABLUE SHIELD PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G55089CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
LJR Neuro Interventional Medical Group Inc Diagnostic Radiology Past Accepting new patients
Imaging Healthcare Specialists Medical Group, Inc. Diagnostic Radiology PastSince Oct 14, 2013 Accepting new patients
La Jolla Radiology Medical Group - Diagnosis, Inc. Diagnostic Radiology Past Accepting new patients
Open Air MRI Centers Medical Group, Inc. Diagnostic Radiology Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206316800000",
    "number": "1447201603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT LA 21632",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911851632",
            "telephone_number": "858-564-1400",
            "fax_number": "858-564-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 SORRENTO VALLEY RD",
            "address_2": "SUITE 320",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211635",
            "telephone_number": "858-454-4235",
            "fax_number": "858-454-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORELAND",
        "first_name": "STEPHEN",
        "middle_name": "I.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2008-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G55089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G550890",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "00G550890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.