Los Alamitos Radiology Group Inc
Organization Active NPI Diagnostic Radiology Physician · Burbank, CA
NPI 1972080356 · NPPES record last updated Jul 27, 2018
Key facts
- NPI
- 1972080356
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- LOS ALAMITOS RADIOLOGY GROUP INC
- Practice address
- 3406 Kildare CT
Burbank, CA 91504-1665 - Phone
- (805) 375-8804
- Fax
- (770) 237-1429
- NPI assigned
- Jul 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Vincent S. Polek, MD
- Title
- Ceo/President
- Phone
- (805) 375-8804
Other NPIs on the same Medicare enrollment 3
Practitioners 4
-
Atabak Allaei, M.D.
-
Bradley David Hatfield, M.D.
-
David Bruce Jackson, M.D.
-
Michael Holmes Secrist, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060816000607 | CA | Part B Supplier - Clinic/Group Practice | 5092718882 |
Receives reassigned benefits from 47 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Los Alamitos, CA; Yorba Linda, CA; Los Angeles, CA; Mission Viejo, CA; Ontario, CA; Palo Alto, CA; Roseville, CA; Sacramento, CA… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
3406 Kildare CT
Burbank, CA 91504-1665
Mailing address
PO Box 650
Newbury Park, CA 91319-0650
Phone (805) 375-8804
NPI Registry JSON
{
"created_epoch": "1532649600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1532649600000",
"number": "1972080356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 650",
"city": "NEWBURY PARK",
"state": "CA",
"postal_code": "913190650",
"telephone_number": "805-375-8804",
"fax_number": "770-237-1429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3406 KILDARE CT",
"city": "BURBANK",
"state": "CA",
"postal_code": "915041665",
"telephone_number": "805-375-8804",
"fax_number": "770-237-1429"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOS ALAMITOS RADIOLOGY GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2018-07-27",
"last_updated": "2018-07-27",
"status": "A",
"authorized_official_last_name": "POLEK",
"authorized_official_first_name": "VINCENT",
"authorized_official_middle_name": "S.",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "805-375-8804",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.