MODESTO RADIOLOGICAL MEDICAL GROUP, INC (NPI# 1740654912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740654912 |
| Entity Type | Organization |
| Organization Name | MODESTO RADIOLOGICAL MEDICAL GROUP, INC |
| Practice Address |
6496 Deer Hollow Dr San Jose CA 95120-1634 |
| Mailing Address |
1524 Mchenry Ave Suite 430 Modesto CA 95350-4500 |
| Practice Telephone | 5594554009 |
| Practice Fax Number | 9165330313 |
| Mailing Telephone | 5594554009 |
| Mailing Fax Number | 9165330313 |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2016-01-27 |
| Authorized Official Name | MARK MOORE (CFO/COO) |
| Authorized Official Telephone | 2093425946 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255872552 | Modesto Radiological Medical Group, Inc | Radiology | 3421 Deep Waters Ct, Simi Valley, CA 93065-0587 | 2017-03-20 |
| 1134670656 | Modesto Radiological Medical Group, Inc | Radiology | 8673 Julie Lynne Cir, Tracy, CA 95304-9207 | 2016-10-19 |
| 1073969838 | Modesto Radiological Medical Group, Inc | Radiology | 148 Beachview Ave, Santa Cruz, CA 95060-3008 | 2016-05-11 |
| 1992170542 | Modesto Radiological Medical Group, Inc | Radiology | 728 Murphy Dr, San Mateo, CA 94402-3421 | 2015-12-08 |
| 1023482296 | Modesto Radiological Medical Group, Inc | Radiology | 6729 Monte Rd, San Luis Obispo, CA 93401-8050 | 2015-11-25 |
| 1861866022 | Modesto Radiological Medical Group, Inc | Radiology | 1648 Dalton Rd, Palos Verdes Estates, CA 90274-1835 | 2015-11-25 |
| 1760856934 | Modesto Radiological Medical Group, Inc | Radiology | 2132 Lysander Way, Roseville, CA 95661-3220 | 2015-11-25 |
| 1154808095 | Modesto Radiological Medical Group, Inc | Radiology | 3750 Whitman Cir, Carmel, CA 93923-8326 | 2018-07-24 |
| 1881198604 | Modesto Radiological Medical Group, Inc | Radiology | 1202 Chelshurst Way, Spring, TX 77379-3247 | 2018-03-19 |
| 1063953362 | Modesto Radiological Medical Group, Inc | Radiology | 1200 4th St, Apt 103, San Francisco, CA 94158-2392 | 2017-03-20 |
| Street Address |
6496 DEER HOLLOW DR |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95120-1634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558322180 | Michael Glenn Myers | Radiology | 6496 Deer Hollow Dr, San Jose, CA 95120-1634 | 2006-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386117554 | Karen Patterson | Speech-Language Pathologist | 6052 Cecala Dr, San Jose, CA 95120 | 2019-01-09 |
| 1881116705 | Geetha M Narayanan | Marriage & Family Therapist | 1051 Mountain Shadows Road, San Jose, CA 95120 | 2017-07-12 |
| 1164849592 | Vicente Ceja | Physical Therapist | 6155 Almaden Expy., # 150, San Jose, CA 95120 | 2014-03-24 |
| 1881018562 | Kirsten Cooper | Acupuncturist | 6055 Meridian Ave Ste 30, San Jose, CA 95120 | 2014-02-14 |
| 1699034587 | Mahboobe Ahmadi | Speech-Language Pathologist | 6554 Mcabee Rd., San Jose, CA 95120 | 2012-05-11 |
| 1679860142 | Nicole L Lewis | Family Medicine | 6475 Camden Ave Ste 105, San Jose, CA 95120 | 2011-07-06 |
| 1659677243 | Sundus Ali | Pediatrics | 6489 Camden Ave Ste 102, San Jose, CA 95120 | 2011-01-31 |
| 1851513659 | Abir Tadros | Dentist | 1041 Mazzone Dr., San Jose, CA 95120 | 2007-05-02 |
| 1053472365 | Clara Nancy Andirious | Dentist | 6472 Camden Ave., Suite 100, San Jose, CA 95120 | 2006-12-12 |
| 1104922384 | Timothy Tuan Lai | Dentist | 5945 Almaden Expressway, Suite #160, San Jose, CA 95120 | 2006-09-15 |
| Find all providers in zip 95120 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518428812 | Alexander Diaz | Radiology | 75 South Bascom Ave, San Jose, CA 95128 | 2019-03-28 |
| 1174814214 | Bhargav Raman | Radiology | 2039 Forest Ave Ste 205, San Jose, CA 95128-4817 | 2011-04-25 |
| 1649596792 | Omnirad Medical Group, Inc. | Radiology | 2410 Samaritan Dr Ste 101, San Jose, CA 95124-3909 | 2010-04-14 |
| 1275775207 | Priyanka Jha | Radiology | 750 Cedarville Ln, San Jose, CA 95133-2076 | 2009-04-06 |
| 1346345360 | John Randolph Jinkins | Radiology | 828 S Bascom Ave Ste 110, San Jose, CA 95128-2652 | 2006-09-14 |
| 1356352660 | Radiological Associates Medical Group, Inc | Radiology | 2410 Samaritan Drive, Suite 102, San Jose, CA 95124-3909 | 2006-08-11 |
| 1780621763 | California Advanced Imaging Medical Assoc., Inc. | Radiology | 550 S Winchester Blvd Ste 110, San Jose, CA 95128-2526 | 2006-05-31 |
| 1558322180 | Michael Glenn Myers | Radiology | 6496 Deer Hollow Dr, San Jose, CA 95120-1634 | 2006-03-31 |
| 1568453421 | Rory Satterfield | Radiology | 798 S Winchester Blvd, San Jose, CA 95128-2928 | 2005-10-31 |
| 1528054582 | Glenn Strome | Radiology | 3031 Tisch Way Ste 400, San Jose, CA 95128-2531 | 2005-09-26 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.