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Individual provider Active NPI

Dylan Denault, DO

  • Diagnostic Radiology Physician
  • Orange, CA
National Provider Identifier
1649739418
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
20A22762 Issued in CA
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 456-7890
NPI assigned
Mar 19, 2019
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 20A22762 CA Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

200 S Manchester Ave Ste 300
Orange, CA 92868-3219
Phone (714) 456-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240521000459 CA Practitioner - Diagnostic Radiology 4385065143 Reassigns benefits to 1 organization
I20250728001508 CO Practitioner - Diagnostic Radiology 4385065143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
College of Osteo Med of the Pacific at Pomona, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Radiologists, P.C.Group PAC ID 7517959794, 11 clinicians
Parkwest Imaging, L.L.CGroup PAC ID 3173415247, 11 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

3676 Parker Blvd
Suite 165
Pueblo, CO 81008-2212
Phone (719) 595-7600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Southern Colorado Radiologists, P.C. CurrentSince Jul 1, 2025 Accepting new patients
Parkwest Imaging, L.L.C Diagnostic Radiology CurrentSince Jul 1, 2025 Accepting new patients
UC Regents Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Radiology Associates Diagnostic Radiology PastSince Jul 1, 2025 Accepting new patients

Locations

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

3676 Parker Blvd
Ste 165
Pueblo, CO 81008
Phone (719) 253-7040

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

Organizations & group practices 5

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

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1649739418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MANCHESTER AVE STE 300",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683219",
            "telephone_number": "714-456-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENAULT",
        "first_name": "DYLAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "20A22762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.