NPIMap

Organization Active NPI

Humboldt Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Fortuna, CA
National Provider Identifier
1942709803
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
HUMBOLDT RADIOLOGY MEDICAL GROUP INC
Practice address
3300 Renner Dr
Fortuna, CA 95540-3120
Phone
(707) 725-3361
NPI assigned
Feb 6, 2018
Last updated
Feb 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

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

Authorized official

Name
Laura Albright
Title
Business Manager
Phone
(707) 442-7814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

3300 Renner Dr
Fortuna, CA 95540-3120

Mailing address

PO Box 6428
Eureka, CA 95502-6428

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041217000800 CA Part B Supplier - Clinic/Group Practice 4082500046 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eureka, CA; Fortuna, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Humboldt Radiology Me D8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1942709803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6428",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955026428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 RENNER DR",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955403120",
            "telephone_number": "707-725-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "ALBRIGHT",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "707-442-7814"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fortuna, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; 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.