NPIMap

Organization Active NPI

Pronet Imaging Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1528099488
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PRONET IMAGING MEDICAL GROUP, INC.
Practice address
1516 Cotner Ave
Los Angeles, CA 90025-3303
Phone
(310) 445-2800
Fax
(310) 445-2816
NPI assigned
Jul 6, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
John V. Crues III, MDNPI 1255333480
Title
President
Phone
(310) 445-2800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 336

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

View all 336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050721000831 CA Part B Supplier - Clinic/Group Practice 5890722755 Receives reassigned benefits from 311 practitioners
Practice locations: Carlsbad, CA; Cupertino, CA; La Canada, CA; Los Angeles, CA; Newport Beach, CA; Palo Alto, CA; Redondo Beach, CA; Sunnyvale, CA…
O20120402000586 FL Part B Supplier - Clinic/Group Practice 5890722755 Receives reassigned benefits from 5 practitioners
Practice locations: Titusville, FL; Weston, FL; St Petersburg, FL; Tampa, FL; Fort Lauderdale, FL; Miami Beach, FL

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

NPPES NPI Registry

Primary practice location

1516 Cotner Ave
Los Angeles, CA 90025-3303

Mailing address

1516 Cotner Ave
Los Angeles, CA 90025-3303
Phone (310) 445-2800

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
ZZZ53357ZOtherCABLUE SHIELD
GR0101600MedicaidCA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 24, 2012.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1528099488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2800",
            "fax_number": "310-445-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2800",
            "fax_number": "310-445-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRONET IMAGING MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "CRUES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-445-2800",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ53357Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.