Southern California Vascular Associates, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

2410301 Issued in CA

Legal business name

SOUTHERN CALIFORNIA VASCULAR ASSOCIATES, INC.

Doing business as

Beyond Basic Imaging Laboratory

Practice address

1310 W Stewart Dr Ste 406
Orange, CA 92868-3855

Phone

(714) 532-0793

Fax

(714) 516-1932

NPI assigned

Jul 4, 2006

Last updated

Jun 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. William J. Foley, M.D.NPI 1700856598

Title

President

Phone

(714) 532-0793

Specialties & licenses 1

Addresses

Other names 1

• Beyond Basic Imaging Laboratory Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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 4

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.

• William John Foley, M.D.

  • Specialist
  • Anaheim, CA
  • NPI 1700856598
  Medicare reassignment Care Compare group NPD Authorized official
• Russell Scott Montgomery, M.D.

  • Specialist
  • Anaheim, CA
  • NPI 1386624526
  Medicare reassignment Care Compare group NPD
• Jeffrey Lawrence Ballard, M.D.

  • Vascular Surgery Physician
  • Orange, CA
  • NPI 1205837200
  Medicare reassignment Care Compare group
• Krista Nakamura, PA-C

  • Physician Assistant
  • Fullerton, CA
  • NPI 1154053148
  Medicare reassignment

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1912937814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 W STEWART DR STE 406",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683855",
            "telephone_number": "714-532-0793",
            "fax_number": "714-780-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W STEWART DR STE 406",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683855",
            "telephone_number": "714-532-0793",
            "fax_number": "714-516-1932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 W La Palma Ave Ste 211",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928012815",
            "country_code": "US",
            "telephone_number": "714-778-1032",
            "fax_number": "714-871-2530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Valencia Mesa Dr Ste 211",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928353817",
            "country_code": "US",
            "telephone_number": "714-871-6879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA VASCULAR ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "FOLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-532-0793",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "2410301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beyond Basic Imaging Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beyond Basic Imaging Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Zephyr Souza-Zimmerman
• Piotr Szczepan Sowa, M.D.
• Sheeva Sowdagar
• James Lai Sowers, MD, PHD
• Deborah Johnson Spandikow, PMHNP

• Specialist in Orange, CA
• Providers in Orange, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.