NPIMap

Organization Active NPI

Centrelake Medical Group Inc

Doing business as Westwood Open MRI

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1790494128
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
CENTRELAKE MEDICAL GROUP INC
Doing business as
Westwood Open MRI
Practice address
10921 Wilshire Blvd
Mezzanine Level
Los Angeles, CA 90024-3906
Phone
(310) 208-3100
Fax
(310) 208-3101
NPI assigned
Nov 15, 2022
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Nishant Niroola
Title
Center Operations Director
Phone
(909) 242-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X NU Primary

Addresses

Primary practice location

10921 Wilshire Blvd
Mezzanine Level
Los Angeles, CA 90024-3906

Mailing address

10921 Wilshire Blvd
Mezzanine Level
Los Angeles, CA 90024-3906
Phone (310) 208-3100

Other names 1

  • Westwood Open MRI Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230728002136 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1658471123 Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Centrelake Imaging Oncolog10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1900 E La Palma Ave
Ste E
Anaheim, CA 92805
Phone (714) 289-6049

10226 Lakewood Blvd
Downey, CA 90241
Phone (562) 287-7209

10226 Lakewood Blvd
Apt C
Downey, CA 90241
Phone (626) 773-7720

10921 Wilshire Blvd
Ste Mezz
Los Angeles, CA 90024
Phone (310) 208-3100

1700 W West Covina Pkwy
Fl 2
West Covina, CA 91790
Phone (626) 773-7720

1700 W West Covina Pkwy
Ste 200
West Covina, CA 91790
Phone (909) 242-7331

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 11

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": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1790494128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10921 WILSHIRE BLVD",
            "address_2": "MEZZANINE LEVEL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900243906",
            "telephone_number": "310-208-3100",
            "fax_number": "310-208-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10921 WILSHIRE BLVD",
            "address_2": "MEZZANINE LEVEL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900243906",
            "telephone_number": "310-208-3100",
            "fax_number": "310-208-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRELAKE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "NIROOLA",
        "authorized_official_first_name": "NISHANT",
        "authorized_official_title_or_position": "CENTER OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "909-242-7300"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westwood Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.