CMG Clinical Laboratory and Ancillary Services, Inc.

Primary specialty

Nuclear Medicine PhysicianTaxonomy code 207U00000X

Legal business name

CMG CLINICAL LABORATORY AND ANCILLARY SERVICES, INC.

Practice address

1866 N Orange Grove Ave
Suite #101
Pomona, CA 91767-3031

Phone

(909) 622-8451

Fax

(909) 620-2560

NPI assigned

Jan 22, 2007

Reactivated

Jun 6, 2023

Organization subpart

No

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

Authorized official

Name

Adrienne M Walker

Title

Contracts Administrator

Phone

(909) 398-1550

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Haritha R Alla, M.D.

  • Cardiovascular Disease Physician
  • Rancho Cucamonga, CA
  • NPI 1487739835

  Nuclear Cardiology

  NPD
• Nadir Ali Eltahir, MD

  • Pulmonary Disease Physician
  • Pomona, CA
  • NPI 1053389338
  NPD
• Muthusamy Muthiah, MD

  • Cardiovascular Disease Physician
  • Pomona, CA
  • NPI 1679541148
  NPD
• Bhavi Paresh Pandya, M.D.

  • Interventional Cardiology Physician
  • Pomona, CA
  • NPI 1467892059

  Nuclear Cardiology

  NPD
• Gaurav R Parikh, MD

  • Cardiovascular Disease Physician
  • Pomona, CA
  • NPI 1144494550
  NPD
• Krishna Anurag Pulumati, MD

  • Cardiovascular Disease Physician
  • Pomona, CA
  • NPI 1982044244
  NPD
• Rakesh Sinha, M.B.B.S., M.D.

  • Pulmonary Disease Physician
  • Pomona, CA
  • NPI 1306006358
  NPD
• Nitanth Reddy Vangala, M.D.

  • Interventional Cardiology Physician
  • Pomona, CA
  • NPI 1861690141
  NPD
• George Keith Edwards, M.D.

  • Nuclear Medicine Physician
  • Santa Monica, CA
  • NPI 1538125489
  NPD (past)
• Sudathi Jeereddi, MD

  • Family Medicine Physician
  • Pomona, CA
  • NPI 1609844984
  NPD (past)

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1497809297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 N ORANGE GROVE AVE",
            "address_2": "SUITE #101",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673031",
            "telephone_number": "909-622-8451",
            "fax_number": "909-620-2560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "914 W Foothill Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917863785",
            "country_code": "US",
            "telephone_number": "909-285-6717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8330 Red Oak St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917300603",
            "country_code": "US",
            "telephone_number": "909-987-4922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CMG CLINICAL LABORATORY AND ANCILLARY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2023-11-13",
        "certification_date": "2023-09-25",
        "deactivation_date": "2023-03-10",
        "reactivation_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CONTRACTS ADMINISTRATOR",
        "authorized_official_telephone_number": "909-398-1550"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Clayton, OTR/L
• Miranda Cleary
• Alyssa Lynn Cline
• Noah Michael Cline
• Clinvex LLC
• Vince Aaron Gosoco Co
• Taylor Coates
• Kassandra Cobb-Nwadigo, CMT
• Desiree Janae Cobian
• Sadie Elizabeth Cochenour

• Nuclear Medicine Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Nuclear Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.