Individual provider Active NPI

Vijendra Rao, MD

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1699799833
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A91225 Issued in CA
Practice address
1516 Cotner Ave
Los Angeles, CA 90025-3303
Phone
(310) 445-2951
Fax
(310) 479-1459
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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 A91225 CA Primary

Addresses

Primary practice location

1516 Cotner Ave
Los Angeles, CA 90025-3303

Mailing address

1516 Cotner Ave
Los Angeles, CA 90025-3303
Phone (310) 445-2951

Other identifiers 5

IdentifierTypeStateIssuer
GR0106039MedicaidCA
GR0106035MedicaidCA
GR010603DMedicaidCA
00A912250MedicaidCA
GR0025330MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061003000669 CA Practitioner - Nuclear MedicinePractitioner - Diagnostic Radiology 8921003583 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nuclear MedicineAlso: Diagnostic Radiology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

1425 S Main St
Walnut Creek, CA 94596-5318
Phone (925) 295-4000

Hospital & facility affiliations

  • Kaiser Foundation Hospital - Antioch Hospital, Antioch, CA, CCN 050760
  • Kaiser Foundation Hospital - Roseville Hospital, Roseville, CA, CCN 050772
  • Kaiser Foundation Hospital - Walnut Creek Hospital, Walnut Creek, CA, CCN 050072

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A91225CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
I V Radiology Medical Group Diagnostic Radiology CurrentSince Jul 4, 2011 Accepting new patients
Pronet Imaging Medical Group, Inc. Diagnostic Radiology CurrentSince Apr 15, 2009 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology CurrentSince May 19, 2021 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology Current Accepting new patients
San Fernando Valley Interventional Radiology and Imaging Center CurrentSince Jun 1, 2009 Accepting new patients
Permanente Medical Group, Inc CurrentSince May 19, 2021 Accepting new patients
Beverly Radiology Medical Group Diagnostic Radiology Past Accepting new patients
Kern Radiology Medical Group, Inc Diagnostic Radiology PastSince Jun 1, 2010 Accepting new patients
Radmol Pet Center, LLC Diagnostic Radiology Past Accepting new patients
Santa Ana Tustin Radiology Medical Group Diagnostic Radiology Past Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

16311 Ventura Blvd
Ste 120
Encino, CA 91436
Phone (818) 817-7707

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

1516 Cotner Ave
Los Angeles, CA 90025
Phone (310) 445-2843

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

1425 S Main St
Walnut Creek, CA 94596
Phone (925) 295-4130

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Organizations & group practices 11

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

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1699799833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2951",
            "fax_number": "310-479-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2951",
            "fax_number": "310-479-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAO",
        "first_name": "VIJENDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A91225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0106039",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0106035",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR010603D",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A912250",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0025330",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1425 S Main St",
            "city": "Walnut Creek",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945965318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.