Provider Demographics
NPI:1710182688
Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC.
Other - Org Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GASCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-646-8300
Mailing Address - Street 1:1500 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:916-646-8300
Mailing Address - Fax:916-920-4434
Practice Address - Street 1:1500 EXPO PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4227
Practice Address - Country:US
Practice Address - Phone:916-646-8300
Practice Address - Fax:916-920-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002851XMedicaid
CAGR0092580Medicaid
CAGR0092581Medicaid
CAGR0092582Medicaid
CAGR00285IRMedicaid
CAZZZ00263ZMedicaid
CAGR0028514Medicaid
CAGR0028517Medicaid
CAGR0028516Medicaid
CAGR0028519Medicaid
CAZZZ24943ZMedicare ID - Type Unspecified
CAZZZ86038ZMedicare ID - Type Unspecified
CAGR0092580Medicaid
CAGR0028514Medicaid
CAZZZ27152ZMedicare ID - Type Unspecified
CAZZZ14323ZMedicare ID - Type Unspecified
CAGR0092582Medicaid
CAGR0028515Medicare ID - Type Unspecified
CAGR00285IRMedicaid
CAGR0028516Medicaid