MEDICARE: SUMMIT RIDGE CALDERON PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085R0205X	Radiological Physics Physician
2	2085N0700X	Neuroradiology Physician
3	2085N0904X	Nuclear Radiology Physician
4	261QR0208X	Mobile Radiology Clinic/Center
5	261QR0206X	Mammography Clinic/Center
6	261QR0200X	Radiology Clinic/Center
7	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician
8	2085P0229X	Pediatric Radiology Physician
9	2085B0100X	Body Imaging Physician
10	2085R0204X	Vascular & Interventional Radiology Physician
11	2085R0001X	Radiation Oncology Physician
12	2085R0203X	Therapeutic Radiology Physician
13	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician
14	111NR0200X	Radiology Chiropractor
15	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1972455236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT RIDGE CALDERON PC

Provider Business Mailing Address
First Line	:	3000 W CHARLESTON BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1981
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8345 S RAINBOW BLVD.
Second Line	:	SUITE 170
City	:	LAS VEGAS
State	:	NV
Zip	:	89113
Country	:	US
Telephone Number	:	702-334-1919
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BENITO CALDERON JR.
Credential	:	MD
Telephone Number	:	702-334-1919

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	06/02/2026

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