NPIMap

Organization Active NPI

Humboldt Radiology Medical Group Inc

  • Diagnostic Radiology Physician
  • Eureka, CA
National Provider Identifier
1972655058
Registry record updated Sep 11, 2008
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
2200 Harrison Ave
Eureka, CA 95501-3215
Phone
(707) 445-8121
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

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

Authorized official

Name
Mrs. Nancy Louise Cobine
Title
Billing Manager
Phone
(707) 445-5431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2200 Harrison Ave
Eureka, CA 95501-3215

Mailing address

PO Box 6428
Eureka, CA 95502-6428
Phone (707) 445-5431

Other identifiers 2

IdentifierTypeStateIssuer
GR0015540MedicaidCA
CN3976OtherRAILROAD MEDICARE

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 Medi8 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.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1972655058",
    "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",
            "telephone_number": "707-445-5431",
            "fax_number": "707-445-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HARRISON AVE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013215",
            "telephone_number": "707-445-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT RADIOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "COBINE",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "707-445-5431",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "GR0015540",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN3976",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.