NPIMap

Organization Active NPI

Modesto Radiological Medical Group, Inc

  • Diagnostic Radiology Physician
  • San Jose, CA
National Provider Identifier
1740654912
Registry record updated Jan 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MODESTO RADIOLOGICAL MEDICAL GROUP, INC
Practice address
6496 Deer Hollow Dr
San Jose, CA 95120-1634
Phone
(559) 455-4009
Fax
(916) 533-0313
NPI assigned
Nov 25, 2015
Last updated
Jan 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2016

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

Authorized official

Name
Mark Moore
Title
Cfo/Coo
Phone
(209) 342-5946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

6496 Deer Hollow Dr
San Jose, CA 95120-1634

Mailing address

1524 McHenry Ave
Suite 430
Modesto, CA 95350-4500
Phone (559) 455-4009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513000453 CA Part B Supplier - Clinic/Group Practice 2062300239 Receives reassigned benefits from 104 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1448409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1740654912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 MCHENRY AVE",
            "address_2": "SUITE 430",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504500",
            "telephone_number": "559-455-4009",
            "fax_number": "916-533-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6496 DEER HOLLOW DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951201634",
            "telephone_number": "559-455-4009",
            "fax_number": "916-533-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO RADIOLOGICAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-25",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "209-342-5946"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.