NPIMap

Organization Active NPI

Simi Radiology and Imaging Medical Group

  • Diagnostic Radiology Physician
  • Simi Valley, CA
National Provider Identifier
1730132275
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SIMI RADIOLOGY AND IMAGING MEDICAL GROUP
Practice address
2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone
(805) 955-6360
NPI assigned
May 18, 2006
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Eric Cordes, M.D.
Title
Managing Partner
Phone
(805) 955-6360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2975 Sycamore Dr
Simi Valley, CA 93065-1201

Mailing address

4100 Guardian St Ste 205
Simi Valley, CA 93063-6721
Phone (805) 522-5940

Other identifiers 5

IdentifierTypeStateIssuer
GR0050171MedicaidCA
ZZZ34708ZOtherBLUE SHIELD
CO8000OtherRAILROAD MEDICARE
GR0050170MedicaidCA
ZZZ30810ZOtherBLUE SHIELD

National Provider Directory

National Provider Directory

Locations

124 Macaw Ln
Simi Valley, CA 93065
Phone (805) 306-0304

40 W Cochran St
Ste 212
Simi Valley, CA 93065

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 58

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.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1730132275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 GUARDIAN ST STE 205",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930636721",
            "telephone_number": "805-522-5940",
            "fax_number": "805-522-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 SYCAMORE DR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651201",
            "telephone_number": "805-955-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMI RADIOLOGY AND IMAGING MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "CORDES",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "805-955-6360",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0050171",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ34708Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CO8000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0050170",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ30810Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.