NPIMap

Organization Active NPI

Glendora Radiological Assoc Inc

  • Diagnostic Radiology Physician
  • Covina, CA
National Provider Identifier
1992797070
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GLENDORA RADIOLOGICAL ASSOC INC
Practice address
414 E San Bernardino Rd
Covina, CA 91723-1704
Phone
(626) 339-5464
Fax
(626) 331-2313
NPI assigned
Aug 16, 2005
Last updated
Oct 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

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

Authorized official

Name
David J. Underwood, MDNPI 1023080686
Title
President
Phone
(626) 339-5464

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 Physician 2085R0202X NU Primary

Addresses

Primary practice location

414 E San Bernardino Rd
Covina, CA 91723-1704

Mailing address

414 E San Bernardino Rd
Covina, CA 91723-1704
Phone (800) 475-3698

Other identifiers 5

IdentifierTypeStateIssuer
GR0011500MedicaidCA
CP3326OtherCARAIL ROAD MEDICARE GRP #
ZZZ14525ZOtherCABLUE SHIELD PROVIDER
GR0011502MedicaidCA
ZZZ35484ZOtherCABLUE SHIELD PROVIDER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070815000331 CA Part B Supplier - Clinic/Group Practice 2163514589 Receives reassigned benefits from 32 practitioners
Practice locations: San Francisco, CA; West Covina, CA; Walnut Creek, CA; San Luis Obispo, CA; Newbury Park, CA; Covina, CA; Glendora, CA; Mission Viejo, CA…

National Provider Directory

National Provider Directory
Tax ID family
Glendora Radiological Associates Inc3 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

1397 S Grand Ave
#3326
Glendora, CA 91740

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": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1992797070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 E SAN BERNARDINO RD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231704",
            "telephone_number": "800-475-3698",
            "fax_number": "626-331-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 E SAN BERNARDINO RD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231704",
            "telephone_number": "626-339-5464",
            "fax_number": "626-331-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDORA RADIOLOGICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-339-5464",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0011500",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE GRP #",
            "identifier": "CP3326",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER",
            "identifier": "ZZZ14525Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0011502",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER",
            "identifier": "ZZZ35484Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.