Intermed Imaging a Medical Corporation

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

C33935 Issued in CA

Legal business name

INTERMED IMAGING A MEDICAL CORPORATION

Practice address

880 E Tuolumne Rd
Turlock, CA 95382-1548

Phone

(310) 671-9754

Fax

(310) 671-3916

NPI assigned

Jan 24, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Walter Preston Maynard, M.D.NPI 1003838301

Title

President/Radiologist

Phone

(310) 671-9754

Specialties & licenses 8

Addresses

Other identifiers 3

Practitioners 1

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

• Walter Preston Maynard, M.D.

  • Diagnostic Radiology Physician
  • Inglewood, CA
  • NPI 1003838301

  Body Imaging

  NPD (past) Authorized official

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1649575671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N PRAIRIE AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011904",
            "telephone_number": "310-671-9754",
            "fax_number": "310-671-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 E TUOLUMNE RD",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953821548",
            "telephone_number": "310-671-9754",
            "fax_number": "310-671-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMED IMAGING A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-24",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "PRESIDENT/RADIOLOGIST",
        "authorized_official_telephone_number": "310-671-9754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Pediatric Radiology",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C33935",
            "primary": true
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "C33935",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "C33935",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "C33935",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NO CA",
            "identifier": "00C339353",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID NO CA",
            "identifier": "00C339350",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Turlock, CA
• Providers in Turlock, 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 Mar 7, 2023; 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.