NPIMap

Organization Active NPI

Merced Radiology Medical Group

  • Diagnostic Radiology Physician
  • Merced, CA
National Provider Identifier
1992796643
Registry record updated Oct 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
8126 Issued in CA
Legal business name
MERCED RADIOLOGY MEDICAL GROUP
Practice address
731 E Yosemite Ave
Suite B-170
Merced, CA 95340-8039
Phone
(209) 342-2300
Fax
(209) 524-4240
NPI assigned
Nov 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2008

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

Authorized official

Name
Mark A Wagner, DO
Title
Director
Phone
(209) 342-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 8126 CA Primary

Addresses

Primary practice location

731 E Yosemite Ave
Suite B-170
Merced, CA 95340-8039

Mailing address

4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300

Other identifiers 9

IdentifierTypeStateIssuer
GR0005283MedicaidCA
GR0005286MedicaidCA
GR0005289MedicaidCA
GR0005282MedicaidCA
GR0005287MedicaidCA
ZZZ25145ZOtherCABLUE SHIELD
GR0005280MedicaidCA
GR0005281MedicaidCA
GR0005285MedicaidCA

National Provider Directory

National Provider Directory

Locations

1 Federal Way
Atwater, CA 95301
Phone (209) 386-4661

1020 Ventura Ave
Chowchilla, CA 93610
Phone (209) 665-0275

388 E Yosemite Ave
Merced, CA 95340
Phone (209) 383-3456

731 E Yosemite Ave
Ste B170
Merced, CA 95340
Phone (209) 722-9729

394 E Yosemite Ave
Ste 200
Merced, CA 95340
Phone (209) 383-3990

315 Mercy Ave
Ste 151
Merced, CA 95340
Phone (209) 722-9729

3600 Sisk Rd
Ste 1A
Modesto, CA 95356
Phone (800) 889-4144

Practitioners & affiliated clinicians

Practitioners 9

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": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1992796643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 NORTHSTAR WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569262",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E YOSEMITE AVE",
            "address_2": "SUITE B-170",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953408039",
            "telephone_number": "209-342-2300",
            "fax_number": "209-524-4240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCED RADIOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "209-342-2300",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "8126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005283",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005286",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005289",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005282",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005287",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ25145Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005280",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005281",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005285",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merced, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.