Broadway Imaging Medical Center

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A71010 Issued in CA

Legal business name

BROADWAY IMAGING MEDICAL CENTER

Practice address

140 North Glendale Ave
Glendale, CA 91206

Phone

(818) 548-0022

Fax

(818) 548-8385

NPI assigned

May 18, 2006

Last updated

Aug 12, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hosam M Moustafa, MDNPI 1760418149

Title

President

Phone

(818) 548-0022

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Broadway Imaging Medical Center Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

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.

• Hosam Moustafa, MD

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1760418149
  NPD Authorized official
• George Nicholas Welch, MD

  • Cardiovascular Disease Physician
  • Portland, ME
  • NPI 1144258336
  NPD
• Vicken Sarkis Zeitjian, M.D.

  • Cardiovascular Disease Physician
  • San Antonio, TX
  • NPI 1760845036
  NPD

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534032000000",
    "number": "1497708002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 NORTH GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91206",
            "telephone_number": "818-548-0022",
            "fax_number": "818-548-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 NORTH GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91206",
            "telephone_number": "818-548-0022",
            "fax_number": "818-548-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY IMAGING MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2018-08-12",
        "status": "A",
        "authorized_official_last_name": "MOUSTAFA",
        "authorized_official_first_name": "HOSAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-548-0022",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RM1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Magnetic Resonance Imaging (MRI)",
            "state": "CA",
            "license": "A71010",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A71010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A710100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Imaging Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Broadway Imaging Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Broad Horizon Home Health, Inc.
• Broadview Home Health, Inc.
• Broadway Family Optometry
• Broadway Home Health Services, Inc.
• Broadway Hospice, Inc
• Broadway Laser Surgical Institute, Inc.
• Broadway Manor Care Center LLC (Broadway Manor Care Center)
• Broadway Med Group, Inc (Broadway Pharmacy)
• Broadway Smile Boutique
• Broadway Surgery Specialists

• Diagnostic Radiology Physician in Glendale, CA
• Providers in Glendale, 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 Aug 12, 2018; 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.