NPIMap

Organization Active NPI

Medical Insights Diagnostic Centers Concord Professional Corporation

  • Diagnostic Radiology Physician
  • Palm Desert, CA
National Provider Identifier
1982142758
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MEDICAL INSIGHTS DIAGNOSTIC CENTERS CONCORD PROFESSIONAL CORPORATION
Practice address
14 Avenida Andra
Palm Desert, CA 92260-1621
Phone
(559) 455-4109
Fax
(916) 533-0313
NPI assigned
Feb 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Authorized official

Name
Virgil L. Williams, M.D.NPI 1912941469
Title
Ceo
Phone
(510) 357-8300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

14 Avenida Andra
Palm Desert, CA 92260-1621

Mailing address

PO Box 26570
Fresno, CA 93729-6570
Phone (800) 903-0912

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070319000143 CA Part B Supplier - Clinic/Group Practice 3678676350 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berkeley, CA; Escondido, CA; Palm Desert, CA; San Leandro, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Medical Insights Diagnostic Centers Concord Professional Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

3195 Folsom Blvd
Sacramento, CA 95816
Phone (916) 737-3211

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571616000000",
    "number": "1982142758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26570",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296570",
            "telephone_number": "800-903-0912",
            "fax_number": "770-666-9102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 AVENIDA ANDRA",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922601621",
            "telephone_number": "559-455-4109",
            "fax_number": "916-533-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL INSIGHTS DIAGNOSTIC CENTERS CONCORD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-01",
        "last_updated": "2019-10-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-357-8300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.