Western Diagnostic & Therapeutic Radiology Medical Group, Inc.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP, INC.

Doing business as

Western Radiologic Medical Group

Practice address

4640 Admiralty Way
Suite 102
Marina del Rey, CA 90292-6621

Phone

(310) 836-1574

Fax

(310) 836-6925

NPI assigned

Oct 2, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John N. Loizeaux-Witte, M.D.

Title

President

Phone

(310) 836-1574

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Western Radiologic Medical Group Doing business as

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Gardena Radiology Medical Group

  • Diagnostic Radiology Physician
  • Gardena, CA
  • NPI 1174717912
  NPPES parent name
• Western Imaging Center

  • Diagnostic Radiology Physician
  • Culver City, CA
  • NPI 1972696680
  NPPES parent name
• Western Imaging, Marina del Rey

  • Diagnostic Radiology Physician
  • Marina del Rey, CA
  • NPI 1528153665
  NPPES parent name

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339632000000",
    "number": "1700979390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY",
            "address_2": "SUITE 102",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926621",
            "telephone_number": "310-836-1574",
            "fax_number": "310-836-6925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY",
            "address_2": "SUITE 102",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926621",
            "telephone_number": "310-836-1574",
            "fax_number": "310-836-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN DIAGNOSTIC & THERAPEUTIC RADIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-06-14",
        "status": "A",
        "authorized_official_last_name": "LOIZEAUX-WITTE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-836-1574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017071",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017076",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017072",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Radiologic Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Watkins Spine, Inc.
• Robert Green Watkins IV, M.D.
• Robert Green Watkins III, M.D.
• Wesley Ryan MD PC
• Sandie West, LMT
• Western Imaging Marina del Rey Inc
• Western Imaging, Marina del Rey
• Westside Therapy Services
• Emily Whalen, D.P.T.
• La Creasure White, NP-C

• Diagnostic Radiology Physician in Marina del Rey, CA
• Providers in Marina del Rey, 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 Jun 14, 2012; 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.