NPIMap

Organization Active NPI

On-Line Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Murrieta, CA
National Provider Identifier
1790189389
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
ON-LINE RADIOLOGY MEDICAL GROUP INC
Practice address
28062 Baxter Rd
Murrieta, CA 92563-1401
Phone
(559) 455-4068
Fax
(770) 666-9103
NPI assigned
Oct 10, 2014
Last updated
Dec 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Authorized official

Name
Dr. Samuel Salen, M.D.
Title
Cfo
Phone
(951) 786-0801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X CA Primary

Addresses

Primary practice location

28062 Baxter Rd
Murrieta, CA 92563-1401

Mailing address

1770 Iowa Ave
280
Riverside, CA 92507-2430
Phone (951) 786-0801

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100113000708 CA Part B Supplier - Clinic/Group Practice 0648311548 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Malibu, CA; Manhattan Beach, CA; Marina del Rey, CA; Mill Valley, CA; Murietta, CA; Newport Beach, CA; Newport Coast, CA; Oceanside, CA…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543968000000",
    "number": "1790189389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 IOWA AVE",
            "address_2": "280",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072430",
            "telephone_number": "951-786-0801",
            "fax_number": "877-892-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28062 BAXTER RD",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925631401",
            "telephone_number": "559-455-4068",
            "fax_number": "770-666-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON-LINE RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2018-12-05",
        "status": "A",
        "authorized_official_last_name": "SALEN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "951-786-0801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.