NPIMap

Organization Active NPI

UC Regents

Doing business as Uci Health-Fountain Valley Imaging-Warner Ave

  • Diagnostic Radiology Physician
  • Fountain Valley, CA
National Provider Identifier
1902177785
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
UC REGENTS
Doing business as
Uci Health-Fountain Valley Imaging-Warner Ave
UCI Health-Fountain Valley Imaging-Warner
Practice address
11190 Warner Ave
Suite 110
Fountain Valley, CA 92708-4019
Phone
(714) 456-5676
Fax
(714) 456-6216
NPI assigned
Jan 25, 2012
Last updated
May 21, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
UC REGENTSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Randolph Perseverance Siwabessy
Title
Vice President and Chief Financial
Phone
(714) 456-5180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

11190 Warner Ave
Suite 110
Fountain Valley, CA 92708-4019

Mailing address

1500 S Douglass Rd
Suite 200, RT 183
Anaheim, CA 92806-6911
Phone (714) 456-6245

Other names 2

  • UCI HEALTH-FOUNTAIN VALLEY IMAGING-WARNER AVE Doing business as
  • UCI Health-Fountain Valley Imaging-Warner Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120920000474 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9931357746 Practice locations: Fountain Valley, CA
O20240619000285 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3274446182 Practice locations: Fountain Valley, CA

Other NPIs with the same Medicare PAC ID 1

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

  • UC Regents

    dba UCI Radiology Associates

    • Diagnostic Radiology Physician
    • Orange, CA
    • NPI 1346298528

    3274446182

    Same PAC ID

National Provider Directory

National Provider Directory
Part of
UC Irvine Health- Newport Doctors Medical Group- Radiology

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

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 176

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.

View all 176

NPI Registry JSON

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

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1902177785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOUGLASS RD",
            "address_2": "SUITE 200, RT 183",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928066911",
            "telephone_number": "714-456-6245",
            "fax_number": "714-456-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11190 WARNER AVE",
            "address_2": "SUITE 110",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084019",
            "telephone_number": "714-456-5676",
            "fax_number": "714-456-6216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UC REGENTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UC REGENTS",
        "enumeration_date": "2012-01-25",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "SIWABESSY",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "PERSEVERANCE",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CHIEF FINANCIAL",
        "authorized_official_telephone_number": "714-456-5180"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCI HEALTH-FOUNTAIN VALLEY IMAGING-WARNER AVE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCI Health-Fountain Valley Imaging-Warner",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.

Verify at the official NPI Registry.