MEDICARE: RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		CA

General Provider Information

NPI Number	:	1558516179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE RADIOLOGY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 15648
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95852-0648
Country	:	US
Telephone Number	:	559-455-4000
Fax Number	:	559-455-4007

Provider Business Practice Location Address
First Line	:	1770 IOWA AVE
Second Line	:	280
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2430
Country	:	US
Telephone Number	:	951-801-6348
Fax Number	:	951-786-0460

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DONALD R. MASSEE
Credential	:	MD.
Telephone Number	:	951-781-2270

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	08/17/2009

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