Calvin Dale Vidrine, CRA RJ RN

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

10041005 Issued in LA

Practice address

174 Grant Rd
Opelousas, LA 70570-0720

Phone

(337) 594-9637

Fax

(337) 948-4556

NPI assigned

May 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Med Image Management & Consultants LLC

  • Diagnostic Radiology Physician
  • Opelousas, LA
  • NPI 1730161936
  NPD Authorized official
• Gulf Coast Mobile Imaging

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Covington, LA
  • NPI 1659425544
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1639122195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1939",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705711939",
            "telephone_number": "337-942-1915",
            "fax_number": "337-942-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 GRANT RD",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705700720",
            "telephone_number": "337-594-9637",
            "fax_number": "337-948-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDRINE",
        "first_name": "CALVIN",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "CRA RJ RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "10041005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1664669",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2000777340",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wade Randall Veillon, PHARMACIST
• E. Karl Ventre III, M.D.
• Daniel Louis Verret, PA
• Bernetta V Victorian, LAC, CCGC
• Bridgette Michelle Vidrine, D.D.S.
• Dawana Mary Vidrine, LPN
• Samantha Lavergne Vidrine, M.D.
• Vikram S Parmar MD
• Tonya Paige Villemarette, LPN
• Marsha Eve Villery, RPH

• Diagnostic Radiology Physician in Opelousas, LA
• Providers in Opelousas, LA by specialty
• Diagnostic Radiology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; 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.