SPINE AND SPORTS IMAGING LLC (NPI# 1295124352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295124352 |
| Entity Type | Organization |
| Organization Name | SPINE AND SPORTS IMAGING LLC |
| Other Organization Name | SPINE AND SPORTS IMAGING |
| Practice Address |
1120 W. La Veta Avenue Suite 300 Orange CA 92868-4233 |
| Practice Telephone | 9492802561 |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |
| Authorized Official Name | MR. SCOTT LILLY (ADMINISTRATOR) |
| Authorized Official Telephone | 8057018580 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPINE AND SPORTS SPECIALTIES MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
CA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Spine and Sports Imaging | Other Name - Individual/Organization |
| Street Address |
1120 W. LA VETA AVENUE SUITE 300 |
| City | ORANGE |
| State | CA |
| Zip Code | 92868-4233 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536633 | Michael J. Gillman | Orthopaedic Surgery | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4246 | 2005-05-31 |
| 1083240204 | Choc Physicians Network, Inc | Health Maintenance Organization | 1120 W. La Veta Avenue, Suite 450, Orange, CA 92868 | 2020-03-19 |
| 1750770814 | Spine and Sports Urgent Care Center Inc. | Clinic/Center | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4233 | 2015-01-13 |
| 1013306174 | Spine and Sports Specialities Medical Group | Orthopaedic Surgery | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4233 | 2015-01-13 |
| 1043479835 | Andrew Germanovich | Anesthesiology | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4246 | 2008-06-05 |
| 1780747287 | Steve A. Mora | Specialist | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4246 | 2006-12-18 |
| 1215924329 | Gregory D. Carlson | Orthopaedic Surgery | 1120 W. La Veta Avenue, Suite 300, Orange, CA 92868-4246 | 2005-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346859386 | Sadaf Abrishami | Pharmacist | 101 The City Dr S., Orange, CA 92868 | 2020-07-27 |
| 1245869825 | Helena Yijia Hong | Student in an Organized Health Care Education/Training Program | Uci Medical Center, 101 The City Drive, Orange, CA 92868 | 2020-04-06 |
| 1932736527 | Joshua Kristopher Livingston | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, Rte. 128-01, Orange, CA 92868 | 2020-03-24 |
| 1831725894 | Michelle Brown | Student in an Organized Health Care Education/Training Program | 101 The City Dr S. Rte 128-01, Orange, CA 92868 | 2020-03-20 |
| 1093363491 | Kristin Lee | Pharmacist | 132 S. Anita Dr., Orange, CA 92868 | 2019-08-28 |
| 1740834217 | Matthew Brian Mecheal | Dentist | 725 W. La Veta Suite 260, Orange, CA 92868 | 2019-08-01 |
| 1245897990 | Brent Tyler Louie | Student in an Organized Health Care Education/Training Program | 101 The City Drive South Building 3, Route 88, Neuropsychiatric Center Uc Irvine Medical Center, Orange, CA 92868 | 2019-05-28 |
| 1093277972 | Danielle Amato | Student in an Organized Health Care Education/Training Program | Uc Irvine Health 101 The City Drive, City Tower, Ste 40, Orange, CA 92868 | 2019-04-01 |
| 1851852206 | Julia Ting Bu | Student in an Organized Health Care Education/Training Program | Uc Irvine Health, 101 The City Drive, City Tower, Ste 400, Orange, CA 92868 | 2019-03-28 |
| 1326507344 | Harrison Beene Lowder | Student in an Organized Health Care Education/Training Program | 505 S. Main St, Suite 525, Orange, CA 92868 | 2019-03-19 |
| Find all providers in zip 92868 | ||||
| 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 |
|---|---|---|---|---|
| 1538775994 | Richard J. Moran | Radiology | 230 S Main St Ste 101, Orange, CA 92868-3851 | 2020-09-21 |
| 1154825172 | Taylor Wolfe | Radiology | 101 The City Dr S Bldg 20, Orange, CA 92868 | 2018-03-23 |
| 1134677321 | Regional Diagnostic Imaging | Radiology | 6043 E Birdcage Ct, Orange, CA 92869-6015 | 2016-09-15 |
| 1609262047 | David Gedeon | Radiology | 101 The City Dr S Rm 115, Orange, CA 92868-3201 | 2015-04-13 |
| 1316382377 | Mark Duc Tran | Radiology | 101 The City Drive South, Bldg. 1, Room 0115, Route 140, Orange, CA 92868 | 2013-05-05 |
| 1396057576 | Waikeong Wong | Radiology | 101 The City Drive South, Route 140, Orange, CA 92868 | 2010-07-05 |
| 1134443211 | Kenneth Meng | Radiology | 431 S Batavia St Ste 103, Orange, CA 92868-3937 | 2010-03-18 |
| 1528380011 | Christopher Lee | Radiology | 101 The City Dr Rt 140, Orange, CA 92868 | 2010-02-24 |
| 1033151857 | Charles Steven Day | Radiology | 608 Strickland Drive, Orange, TX 77630-4717 | 2006-06-13 |
| 1952300592 | Joseph Barlin Tison | Radiology | 431 S Batavia St, Ste. 103, Orange, CA 92868-3936 | 2005-07-15 |
| Find all providers in ORANGE | ||||
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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.