NPIMap

Organization Active NPI

Pomona Valley Imaging Medical Group Inc

  • Specialist
  • Pomona, CA
National Provider Identifier
1982667911
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
POMONA VALLEY IMAGING MEDICAL GROUP INC
Practice address
1798 N Garey Ave
Pomona, CA 91767-2918
Phone
(909) 825-9535
Fax
(909) 397-0194
NPI assigned
Apr 10, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Johnson Benjamin Lightfoote, MDNPI 1083696637
Title
President
Phone
(909) 825-9535

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
Specialist 174400000X NU Primary

Addresses

Primary practice location

1798 N Garey Ave
Pomona, CA 91767-2918

Mailing address

1798 N Garey Ave
Pomona, CA 91767-2918
Phone (909) 865-9535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, SC, VA, NJ4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20060615000324 CA Part B Supplier - Clinic/Group Practice 6709898562 Receives reassigned benefits from 18 practitioners
Practice locations: San Marino, CA; Pomona, CA; Oakland, CA; Los Angeles, CA; La Verne, CA; Claremont, CA; Chino Hills, CA; Chino, CA…
O20260318000045 SC Part B Supplier - Clinic/Group Practice 6709898562 Receives reassigned benefits from 2 practitioners
Practice locations: Daniel Island, SC; Simpsonville, SC
O20260319000776 VA Part B Supplier - Clinic/Group Practice 6709898562 Receives reassigned benefits from 1 practitioner
Practice locations: Norfolk, VA
O20260323001668 NJ Part B Supplier - Clinic/Group Practice 6709898562 Receives reassigned benefits from 1 practitioner
Practice locations: Ramsey, NJ; Short Hills, NJ

National Provider Directory

National Provider Directory
Tax ID family
Pomona Valley Hospital Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1982667911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1798 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672918",
            "telephone_number": "909-865-9535",
            "fax_number": "909-397-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1798 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672918",
            "telephone_number": "909-825-9535",
            "fax_number": "909-397-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMONA VALLEY IMAGING MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LIGHTFOOTE",
        "authorized_official_first_name": "JOHNSON",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-825-9535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.