NPIMap

Organization Active NPI

Riverside Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Fallbrook, CA
National Provider Identifier
1457653206
Registry record updated Nov 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.
Practice address
3651 Laketree Dr
Fallbrook, CA 92028-9404
Phone
(559) 455-4000
NPI assigned
Nov 30, 2010
Last updated
Nov 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2010

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

Authorized official

Name
Donald R. Massee
Title
President
Phone
(951) 781-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

3651 Laketree Dr
Fallbrook, CA 92028-9404

Mailing address

1660 Chicago Ave
Suite M-17
Riverside, CA 92507-2068

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120509000724 CA Part B Supplier - Clinic/Group Practice 2365412327 Receives reassigned benefits from 36 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rancho Cucamonga, CA; Sacramento, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; San Clemente, CA; Temple City, CA; Torrance, CA…

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1457653206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 CHICAGO AVE",
            "address_2": "SUITE M-17",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 LAKETREE DR",
            "city": "FALLBROOK",
            "state": "CA",
            "postal_code": "920289404",
            "telephone_number": "559-455-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "MASSEE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-781-2273"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fallbrook, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.