Michael James Brydone-Jack, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A172034 Issued in CA

Practice address

101 The City Dr S
Orange, CA 92868-3201

Phone

(714) 456-6595

NPI assigned

Jul 2, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Diagnostic Radiology

Education

Oregon Health Sciences University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radia Oregon Radiology Medical Group LLCGroup PAC ID 2961852637, 122 clinicians

Medford Radiological Group PCGroup PAC ID 2062303324, 91 clinicians

Oregon Advanced Imaging LLCGroup PAC ID 3577465376, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
• Providence Medford Medical Center Hospital, Medford, OR, CCN 380075
• Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005
• Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 27)

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.

• Medford Radiological Group, PC

  • Diagnostic Radiology Physician
  • Medford, OR
  • NPI 1407938111
  Medicare reassignment Care Compare group NPD
• Oregon Advanced Imaging, LLC

  • Magnetic Resonance Imaging Radiologic Technologist
  • Medford, OR
  • NPI 1134416464
  Medicare reassignment Care Compare group NPD
• Radia Oregon Radiology Medical Group LLC

  • Diagnostic Radiology Physician
  • Medford, OR
  • NPI 1073385423
  Medicare reassignment Care Compare group NPD
• IHS Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1497148456

  OR

  Medicare reassignment NPD
• Radia California Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
  • NPI 1740982032

  OR

  Medicare reassignment NPD
• UC Regents

  • Diagnostic Radiology Physician
  • Orange, CA
  • NPI 1346298528
  Medicare reassignment NPD
• Radia Inc P S

  • Diagnostic Radiology Physician
  • Lynnwood, WA
  • NPI 1932196607

  OR

  Medicare reassignment NPD
• UC Regents

  • Diagnostic Radiology Physician
  • Fountain Valley, CA
  • NPI 1902177785
  NPD
• Oregon Advanced Imaging, LLC

  • Magnetic Resonance Imaging Radiologic Technologist
  • Central Point, OR
  • NPI 1689919573
  NPD
• Physicians Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • San Diego, CA
  • NPI 1891741831
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1770587107
  Care Compare affiliation
• Asante Ashland Community Hospital, LLC

  • General Acute Care Hospital
  • Ashland, OR
  • NPI 1730628827
  Care Compare affiliation
• Asante Three Rivers Medical Center, LLC

  • General Acute Care Hospital
  • Grants Pass, OR
  • NPI 1801891809
  Care Compare affiliation
• Providence Health & Services - Oregon

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1689755670
  Care Compare affiliation

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

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1457767154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 MAIN ST APT 430",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-6595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Ave",
            "address_2": "Hennepin County Medical Center",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRYDONE-JACK",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-02",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A172034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Austin Buck
• Derrion Bucklin
• Shirisha R Budarapu, D.D.S

• Diagnostic Radiology Physician in Orange, CA
• Providers in Orange, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.