NPIMap

Organization Active NPI

Kennewick Radiology Group, PC

  • Diagnostic Radiology Physician
  • Walnut Creek, CA
National Provider Identifier
1851865117
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
KENNEWICK RADIOLOGY GROUP, PC
Practice address
215 Tiburon CT
Walnut Creek, CA 94597-3437
Phone
(559) 455-4009
NPI assigned
Jan 18, 2019
Last updated
Jan 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Authorized official

Name
Sandip Patidar, MD
Title
Owner
Phone
(559) 455-4009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

215 Tiburon CT
Walnut Creek, CA 94597-3437

Mailing address

PO Box 4030
Pasco, WA 99302-4030

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190314000693 CA Part B Supplier - Clinic/Group Practice 9335230549 Receives reassigned benefits from 8 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Truckee, CA; Irvine, CA; San Luis Obispo, CA; San Diego, CA; Pasadena, CA; Newport Coast, CA; Roseville, 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

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1851865117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4030",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993024030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 TIBURON CT",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945973437",
            "telephone_number": "559-455-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEWICK RADIOLOGY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "PATIDAR",
        "authorized_official_first_name": "SANDIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-455-4009",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.