St Jude Radiology Medical Group Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

ST JUDE RADIOLOGY MEDICAL GROUP INC

Practice address

101 E Valencia Mesa Dr
Fullerton, CA 92835

Phone

(714) 992-3000

Fax

(714) 992-3928

NPI assigned

Nov 6, 2006

Last updated

Aug 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Renee Nicole Davison

Title

Administrative Assistant

Phone

(714) 992-3200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, MD, DC, WA, WI, HI, WY, OR, TN, CO, TX, AZ, NE, VA, KS, FL, CT, NJ, MI, KY, UT, NY, MN, PA, PR, MS, MA, OK, VT, DE, NC, LA, NM, AL, IN, GA36 enrollments

Enrollment records 36

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Jude Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1255819892

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • South Pasadena, CA
  • NPI 1043732001

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1043732019

  O20040115000501

  Same enrollment
• St. Jude Radiology Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Walnut Creek, CA
  • NPI 1750803722

  O20040115000501

  Same enrollment

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 120

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.

• Brenna Ann Talkin Chalmers, MD

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1306182530
  Medicare reassignment Care Compare group NPD
• Jonathan Patrick Coll, M.D.

  • Diagnostic Radiology Physician
  • Santa Barbara, CA
  • NPI 1679803977
  Medicare reassignment Care Compare group NPD
• Ajita Deodhar, M.D

  • Vascular & Interventional Radiology Physician
  • Los Angeles, CA
  • NPI 1740593458

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Philip Eisinger, DO

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1750371852

  PA

  Medicare reassignment Care Compare group NPD
• Robert Farrell Jr., MD

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1952386476

  TX, VA

  Medicare reassignment Care Compare group NPD
• Richard Keith Hollis, DO

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1831119254

  VA

  Medicare reassignment Care Compare group NPD
• Jane Lee Hur, MD

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1689019804

  DE

  Medicare reassignment Care Compare group NPD
• Chau Quang Huynh, M.D.

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1649434390
  Medicare reassignment Care Compare group NPD
• Bradley A Jackson, M.D.

  • Diagnostic Radiology Physician
  • Fullerton, CA
  • NPI 1124206487
  Medicare reassignment Care Compare group NPD
• Timmy Matthew Joseph, M.D.

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1669639175
  Medicare reassignment Care Compare group NPD
• Kambrie Yukie Kato, M.D.

  • Diagnostic Radiology Physician
  • Walnut Creek, CA
  • NPI 1235424284

  HI

  Medicare reassignment Care Compare group NPD
• Michael Vincent Klein, M.D.

  • Diagnostic Radiology Physician
  • La Jolla, CA
  • NPI 1205826237
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1649349705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-992-3000",
            "fax_number": "714-992-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92835",
            "telephone_number": "714-992-3000",
            "fax_number": "714-992-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "DAVISON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "714-992-3200"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Jude Hospital Yorba Linda (St Joseph Heritage Healthcare)
• St Jude Hospital Yorba Linda (St Joseph Heritage Healthcare)
• St Jude Hospital Yorba Linda (St Joseph Heritage Healthcare)
• St Jude Hospital Yorba Linda (St Joseph Heritage Healthcare)
• St Jude Radiology Medical Group Inc
• St Jude Radiology Medical GRP, Inc
• St, Jude Heritage Medical Group
• St. Elizabeth Healthcare and Rehabilitation Center, LLC (St. Elizabeth Healthcare and Rehabilitation Center)
• St. Jude Hospital, Inc. (St. Jude Mobile Family Health Clinic 2)
• St. Jude Hospital, Inc. (St. Jude Mobile Health Clinic 1)

• Diagnostic Radiology Physician in Fullerton, CA
• Providers in Fullerton, 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 Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.