Active NPI
St Jude Radiology Medical Group Inc
- Diagnostic Radiology Physician
- Fullerton, CA
National Provider Identifier
1649349705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
101 E Valencia Mesa Dr
Fullerton, CA 92835
Mailing address
101 E Valencia Mesa Dr
Fullerton, CA 92835-3809
Phone (714) 992-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ49329Z | Medicaid | CA |
Medicare participation
Medicare enrollment files- 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, GA
Enrollment records 36
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Diagnostic Radiology Physician
- Fullerton, CA
- NPI 1255819892
O20040115000501
-
- Diagnostic Radiology Physician
- South Pasadena, CA
- NPI 1043732001
O20040115000501
-
- Diagnostic Radiology Physician
- Sacramento, CA
- NPI 1043732019
O20040115000501
-
- Diagnostic Radiology Physician
- Walnut Creek, CA
- NPI 1750803722
O20040115000501
National Provider Directory
National Provider DirectoryLocations
2767 E Imperial Hwy
Brea, CA 92821
Phone (714) 578-8706
2151 N Harbor Blvd
Ste 1400
Fullerton, CA 92835
Phone (417) 446-5600
100 E Valencia Mesa Dr
Ste 108
Fullerton, CA 92835
2251 N Harbor Blvd
Fullerton, CA 92835
Phone (714) 449-6230
1525 Rancho Conejo Blvd
Ste 201
Thousand Oaks, CA 91320
Phone (805) 375-8800
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Practitioners & affiliated clinicians
Practitioners 120
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Los Angeles, CA
- NPI 1306182530
-
- Diagnostic Radiology Physician
- Santa Barbara, CA
- NPI 1679803977
-
- Vascular & Interventional Radiology Physician
- Los Angeles, CA
- NPI 1740593458
Diagnostic Radiology
-
- Diagnostic Radiology Physician
- Fullerton, CA
- NPI 1649434390
-
- Diagnostic Radiology Physician
- Fullerton, CA
- NPI 1124206487
-
- Diagnostic Radiology Physician
- Los Angeles, CA
- NPI 1669639175
-
- Diagnostic Radiology Physician
- La Jolla, CA
- NPI 1205826237
NPI Registry JSON
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ49329Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
- 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. Jude Hospital, Inc.
- St. Jude Hospital, Inc.
Sources for this page
- 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.