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	2085P0229X	Pediatric Radiology Physician
2	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician
3	2085R0001X	Radiation Oncology Physician
4	2085R0203X	Therapeutic Radiology Physician
5	2085B0100X	Body Imaging Physician
6	2085R0205X	Radiological Physics Physician
7	261QR0208X	Mobile Radiology Clinic/Center
8	261QR0206X	Mammography Clinic/Center
9	261QR0200X	Radiology Clinic/Center
10	2085N0904X	Nuclear Radiology Physician
11	2085N0700X	Neuroradiology Physician
12	111NR0200X	Radiology Chiropractor
13	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician
14	2085R0204X	Vascular & Interventional Radiology Physician
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	:	02/11/2026

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