Pacific Coast Mobile Radiology, Inc

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

PACIFIC COAST MOBILE RADIOLOGY, INC

Practice address

1440 S State College Blvd Ste 3K
Anaheim, CA 92806-5721

Phone

(714) 758-0660

NPI assigned

Nov 9, 2021

Last updated

Feb 6, 2024By 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

Erik Chavez

Title

Chief Operating Officer

Phone

(714) 758-0660

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659037125. Details of each certification follow.

• CCN 05X0001004 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 05X0001004

Legal name

PACIFIC COAST MOBILE RADIOLOGY, INC

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

May 1, 2023

Last certification

Apr 24, 2023

Ownership / control type

Corporation

Facility address

1440 S State College Blvd, Ste 3K
Anaheim, CA 92806

Locations

Practitioners 1

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.

• Reyna R Chavez

  • Mobile Radiology Clinic/Center
  • Anaheim, CA
  • NPI 1629261375

  Radiology, Mobile Mammography

  NPD

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

{
    "created_epoch": "1636416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1659037125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 S STATE COLLEGE BLVD STE 3K",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928065721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 S STATE COLLEGE BLVD STE 3K",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928065721",
            "telephone_number": "714-758-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COAST MOBILE RADIOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-09",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "714-758-0660"
    },
    "taxonomies": [
        {
            "code": "261QR0207X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile Mammography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.