NPIMap

Organization Active NPI

St Jude Radiology Medical GRP, Inc

  • Diagnostic Radiology Physician
  • Fullerton, CA
National Provider Identifier
1588788152
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST JUDE RADIOLOGY MEDICAL GRP, INC
Practice address
2151 N Harbor Blvd
Fullerton, CA 92835-3801
Phone
(714) 992-3978
Fax
(714) 992-3298
NPI assigned
Mar 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert C Morten, M.D.NPI 1821194440
Title
President
Phone
(714) 992-3978

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X CA Primary

Addresses

Primary practice location

2151 N Harbor Blvd
Fullerton, CA 92835-3801

Mailing address

PO Box 4505
Woodland Hills, CA 91365-4505
Phone (805) 375-8800

National Provider Directory

National Provider Directory
Tax ID family
St Jude Radiology Medical Group Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

251 Imperial Hwy
Ste 471
Fullerton, CA 92835

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588788152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4505",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913654505",
            "telephone_number": "805-375-8800",
            "fax_number": "805-375-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 N HARBOR BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353801",
            "telephone_number": "714-992-3978",
            "fax_number": "714-992-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE RADIOLOGY MEDICAL GRP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORTEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-992-3978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.