Good Shepherd Healthcare LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

GOOD SHEPHERD HEALTHCARE LLC

Doing business as

Medical Imaging and Intervention

Practice address

9395 Magnolia Ave
Riverside, CA 92503-3747

Phone

(714) 801-8878

NPI assigned

Dec 24, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Michael Emeel Mousa, MD

Title

Founder/Owner

Phone

(714) 801-8878

Specialties & licenses 7

Addresses

Other names 2

• Medical Imaging and Intervention Doing business as
• Good Shepherd Healthcare LLC Former legal business name

Locations

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

{
    "created_epoch": "1545609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1609348036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11199 TESOTA LOOP ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928833059",
            "telephone_number": "714-801-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9395 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033747",
            "telephone_number": "714-801-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-24",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "MOUSA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EMEEL",
        "authorized_official_title_or_position": "FOUNDER/OWNER",
        "authorized_official_telephone_number": "714-801-8878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic 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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Imaging and Intervention",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Shepherd Healthcare LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Diagnostic Radiology Physician in Riverside, CA
• Providers in Riverside, 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 Mar 15, 2021; 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.