NPIMap

Organization Active NPI

Radiology Medical Group of Santa Cruz County Inc

  • Diagnostic Radiology Physician
  • Santa Cruz, CA
National Provider Identifier
1619987674
Registry record updated Mar 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC
Practice address
1685 B Commercial Way
Santa Cruz, CA 95065-1703
Phone
(831) 462-0151
Fax
(831) 464-8977
NPI assigned
Aug 9, 2006
Organization subpart
Yes
Parent organization
RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2008

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

Authorized official

Name
Kenneth E Averill Jr., MD
Title
President
Phone
(831) 476-1542

Specialties & licenses 1

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

Addresses

Primary practice location

1685 B Commercial Way
Santa Cruz, CA 95065-1703

Mailing address

1661 Soquel Drive
Building G
Santa Cruz, CA 95065-1709
Phone (831) 476-1542

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ73806ZMedicaidCA
ZZZ85925ZOtherCABLUE SHIELD

Other names 1

  • Santa Cruz Comprehensive Imaging Other name

National Provider Directory

National Provider Directory
Tax ID family
RMG GRP DSCH6 organizations share this tax ID, including this one
Part of
RMG GRP DSCH

Other organizations with this tax ID 5

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

Locations

1685 Commercial Way
#B
Santa Cruz, CA 95065

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1619987674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 SOQUEL DRIVE",
            "address_2": "BUILDING G",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651709",
            "telephone_number": "831-476-1542",
            "fax_number": "831-464-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 B COMMERCIAL WAY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651703",
            "telephone_number": "831-462-0151",
            "fax_number": "831-464-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIOLOGY MEDICAL GROUP OF SANTA CRUZ COUNTY INC",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "AVERILL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "831-476-1542",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73806Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ85925Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Cruz Comprehensive Imaging",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.