Active NPI
Fullerton Radiology Medical Group, Inc
- Diagnostic Radiology Physician
- Anaheim, CA
National Provider Identifier
1861451858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- FULLERTON RADIOLOGY MEDICAL GROUP, INC
- Practice address
- 5528 E la Palma Ave Ste 4a
Anaheim, CA 92807-2115 - Phone
- (714) 993-2000
- Fax
- (714) 524-4216
- NPI assigned
- Mar 20, 2006
- Last updated
- Sep 5, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Michael G Chan, D.O.
- Title
- President
- Phone
- (714) 526-2241
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
5528 E la Palma Ave Ste 4a
Anaheim, CA 92807-2115
Mailing address
3350 E Birch St
Suite 105
Brea, CA 92821-6264
Phone (714) 992-0850
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0006736 | Medicaid | CA | |
| ZZZ74739Z | Medicaid | CA | |
| GR0006731 | Medicaid | CA | |
| ZZZ74739Z | Other | CA | BLUE SHIELD OF CALIF |
| ZZZ642972 | Other | CA | BLUE SHIELD OF CALIF |
| GR0006737 | Medicaid | CA | |
| ZZZ75588Z | Other | CA | BLUE SHIELD OF CALIF |
| GR0006738 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, FL, PR, PA, NJ, MD, DE, DC, IL, CO, TX, MN, NM, MA, NY, VT, NV, AZ, HI, KS, OR, KY, WY, NC, WI, VA, OH, WA, OK, IN, MI, NE
Enrollment records 32
National Provider Directory
National Provider DirectoryLocations
5528 E La Palma Ave
Ste 4A
Anaheim, CA 92807
Phone (714) 970-0200
3350 E Birch St
Ste 105
Brea, CA 92821
380 W Central Ave
Brea, CA 92821
Phone (714) 529-0211
2720 N Harbor Blvd
Fullerton, CA 92835
Phone (714) 526-8325
10111 Hole Ave
Riverside, CA 92503
Phone (650) 299-9906
17451 Bastanchury Rd
Ste 103
Yorba Linda, CA 92886
Phone (714) 961-9300
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Practitioners & affiliated clinicians
Practitioners 122
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.
-
- Diagnostic Radiology Physician
- San Diego, CA
- NPI 1285929067
-
- Diagnostic Radiology Physician
- Long Beach, CA
- NPI 1528008125
-
- Vascular & Interventional Radiology Physician
- Glendale, CA
- NPI 1851657076
Diagnostic Radiology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1725494400000",
"number": "1861451858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3350 E BIRCH ST",
"address_2": "SUITE 105",
"city": "BREA",
"state": "CA",
"postal_code": "928216264",
"telephone_number": "714-992-0850",
"fax_number": "714-526-8271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5528 E LA PALMA AVE STE 4A",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928072115",
"telephone_number": "714-993-2000",
"fax_number": "714-524-4216"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FULLERTON RADIOLOGY MEDICAL GROUP, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-20",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A",
"authorized_official_last_name": "CHAN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "714-526-2241",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"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": "GR0006736",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ74739Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0006731",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIF",
"identifier": "ZZZ74739Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIF",
"identifier": "ZZZ642972",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0006737",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIF",
"identifier": "ZZZ75588Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0006738",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.