NPIMap

Organization Active NPI

St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Orange, CA
National Provider Identifier
1609398676
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ST. JUDE RADIOLOGY MEDICAL GROUP, INC.
Practice address
6043 E Birdcage CT
Orange, CA 92869-6015
Phone
(714) 992-3978
NPI assigned
Jul 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Bradley A. Jackson, MD
Title
Medical Director / Ceo
Phone
(714) 992-3978

Specialties & licenses 1

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

Addresses

Primary practice location

6043 E Birdcage CT
Orange, CA 92869-6015

Mailing address

PO Box 940
Newbury Park, CA 91319-0940

Other practice location 1

1416 Arch Ln
Huntington Beach, CA 92648-3765
Phone (714) 992-3978

Other practice location 2

38 Paperbark
Irvine, CA 92620-3442
Phone (714) 922-3978

Other practice location 3

13632 Tea House St
Santa Ana, CA 92705-2822
Phone (714) 992-3978

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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1609398676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 940",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913190940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6043 E BIRDCAGE CT",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928696015",
            "telephone_number": "714-992-3978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1416 Arch Ln",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926483765",
            "country_code": "US",
            "telephone_number": "714-992-3978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "38 Paperbark",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926203442",
            "country_code": "US",
            "telephone_number": "714-922-3978",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13632 Tea House St",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927052822",
            "country_code": "US",
            "telephone_number": "714-992-3978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. JUDE RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR / CEO",
        "authorized_official_telephone_number": "714-992-3978",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.