JACKSON W PENRY MD
NPI 1003055401
Radiology - Diagnostic Radiology in Mission Viejo, CA

Q: What is Jackson Penry's NPI number?

The NPI number for Jackson Penry is 1003055401. It was assigned to this individual provider in the NPPES registry on February 10, 2009.

Q: What is Jackson Penry's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Q: When was this NPI record last updated?

The NPPES record for Jackson Penry was last updated on July 29, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 10, 2009PECOS EnrolledAccepts Medicare Assignment

75/100

CMS Quality Rating

27700 MEDICAL CENTER ROAD-RADIOLOGY DEPARTMENT, MISSION VIEJO, CA 92691(949) 364-7744 Get Directions Write a Review

NPPES record last updated: July 29, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Jackson W Penry Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON W PENRY MD (NPI 1003055401) is an individual diagnostic radiology provider in Mission Viejo, California, licensed in California (A114302) and active in the NPI registry since February 2009. He is enrolled in Medicare PECOS and is a graduate of Ohio State University College Of Medicine (2006).

NPPES Registry Identity

NPI1003055401

Entity TypeIndividualMale

Primary Taxonomy2085R0202X

Provider Legal NameJACKSON W PENRYCredential: MD

Location Address27700 MEDICAL CENTER ROAD-RADIOLOGY DEPARTMENTMission Viejo, CA 92691-6426

Mailing AddressDept La 21789Pasadena, CA 91185-1789 · (949) 263-8620 · Fax (800) 409-7005

Phone(949) 364-7744

Sole ProprietorNo

Medical School CMSOhio State University College Of MedicineGraduated 2006

Enumeration DateFebruary 10, 2009

Last NPPES UpdateJuly 29, 2014

✔ NPI 1003055401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians

Taxonomy Code2085R0202X

License✔ Licensed in CA · A114302

Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

27700 MEDICAL CENTER ROAD-RADIOLOGY DEPARTMENT, Mission Viejo, CA 92691

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Other Identifiers 5

Medicaid1003055401CA

Medicare PINEZ237ZCA

Other00A1143020CA · Bs/bc Of Ca

Medicare PINEZ237YCA

Medicaid0A1143020CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jackson W Penry Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517144298

PECOS Enrollment IDI20110606000608

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Jackson Penry reassigns Medicare billing to 13 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Beverly Radiology Medical Group III

25 mi

Diagnostic Radiology

710 N EUCLID ST, SUITE 102
Anaheim, CA 92801

Reassigned Medicare billing, California enrollment
Also billed through NPI 1649599085 (California), NPI 1801159736 (California)
349 clinicians in this Medicare group

NPI 1972826774 (714) 517-2099

North County Radiology Associates Inc

44 mi

Vascular & Interventional Radiology

1955 CITRACADO PKWY STE 100
Escondido, CA 92029

Reassigned Medicare billing, California enrollment
19 clinicians in this Medicare group

NPI 1417723024 (760) 940-4055

Cedars-Sinai Medical Care Foundation

53 mi

Specialist

6500 WILSHIRE BLVD FL 15
Los Angeles, CA 90048

Reassigned Medicare billing, California enrollment
2,118 clinicians in this Medicare group

NPI 1316984388 (310) 385-3200

San Diego Diagnostic Radiology Medical Group, Inc.

60 mi

Diagnostic Radiology

8745 AERO DR, SUITE 200
San Diego, CA 92123

Reassigned Medicare billing, California enrollment
71 clinicians in this Medicare group

NPI 1629156583 (858) 565-0950

Ihs Radiology Medical Group, Inc.

63 mi

Diagnostic Radiology

150 W WASHINGTON ST
San Diego, CA 92103

Reassigned Medicare billing, California enrollment
85 clinicians in this Medicare group

NPI 1497148456 (619) 295-9729

Desert Advanced Imaging Medical Center

74 mi

Diagnostic Radiology

72855 FRED WARING DR
Palm Desert, CA 92260

Reassigned Medicare billing, California enrollment
278 clinicians in this Medicare group

NPI 1568416147 (760) 346-1130

Kern Radiology Medical Group, Inc

117 mi

Diagnostic Radiology

432 S MILL ST
Tehachapi, CA 93561

Reassigned Medicare billing, California enrollment
252 clinicians in this Medicare group

NPI 1699294025 (661) 326-9600

Fresno Imaging Center

255 mi

Diagnostic Radiology

6191 N THESTA ST
Fresno, CA 93710

Reassigned Medicare billing, California enrollment
232 clinicians in this Medicare group

NPI 1659456499 (559) 447-2600

Modesto Advanced Diagnostic Imaging Medical Center

339 mi

Diagnostic Radiology

157 E COOLIDGE AVE
Modesto, CA 95350

Reassigned Medicare billing, California enrollment
219 clinicians in this Medicare group

NPI 1730133893 (209) 524-6800

Norcal Imaging

367 mi

Diagnostic Radiology

2201 WALNUT AVE, SUITE # 150
Fremont, CA 94538

Reassigned Medicare billing, California enrollment
238 clinicians in this Medicare group

NPI 1013031772 (510) 713-1234

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 62

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, gadoterate meglumine, 0.1 ml A9575

Gadoterate meglumine is a contrast agent used in MRI scans to help visualize certain areas of your body more clearly. It's injected into your bloodstream, typically through a vein in your arm, and helps doctors get more detailed images.

11,400 services78 patients

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml Q9967

Low osmolar contrast material with 300-399 mg/ml iodine concentration is a diagnostic tool used in imaging procedures. It helps to enhance the visibility of specific areas in the body, aiding in accurate diagnosis. It's safe and generally well-tolerated by patients.

7,301 services68 patients

X-ray of chest, 1 view 71045

A chest X-ray, 1 view, is a quick, painless test that produces images of the structures within your chest, such as your heart, lungs, and blood vessels. It helps in diagnosing conditions like pneumonia, heart problems, or lung cancer. You'll stand in front of a machine that emits X-rays, which pass through your body to create the image.

414 services384 patients

Ct scan head or brain without contrast 70450

A CT scan of the head or brain without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your brain, skull, and other structures inside your head. It helps to detect conditions like strokes, tumors, or injuries. No dye (contrast) is used in this test.

319 services303 patients

Ct scan of upper spine without contrast 72125

A CT scan of the upper spine without contrast is a non-invasive imaging test that uses X-rays to capture detailed images of your neck and upper back. It helps in identifying issues like fractures, tumors, or infections. No dye (contrast) is used in this scan.

148 services144 patients

Ct scan of abdomen and pelvis with contrast 74177

A CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.

81 services80 patients

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries A9552

Fluorodeoxyglucose F-18 FDG is a radioactive drug used in PET scans. It helps doctors see how your tissues and organs are functioning. The drug is given in a specific dose, up to 45 millicuries, depending on your body size and the type of scan.

68 services57 patients

Nuclear medicine study from skull base to mid-thigh with ct scan 78815

A nuclear medicine study from skull base to mid-thigh with a CT scan involves using a small amount of radioactive material and CT imaging to examine body tissues and organs. This helps detect any abnormalities by providing detailed images of the body's internal structure.

64 services55 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

63 services63 patients

Mri scan of lower spinal canal without contrast 72148

An MRI scan of the lower spinal canal without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to produce detailed images of your lower spine. This helps identify issues like disc problems, tumors, or nerve conditions. No dye is used.

63 services62 patients

X-ray of abdomen, 1 view 74018

An X-ray of the abdomen, 1 view, is a quick and painless imaging test. It uses a small amount of radiation to produce images of the structures in your abdomen, such as the stomach, liver, and intestines. This can help identify issues like blockages, infections, or injuries.

50 services46 patients

Ct scan of lower spine without contrast 72131

A CT scan of the lower spine without contrast is a non-invasive imaging test. It uses X-rays to create detailed images of your lower back area, helping to detect conditions like fractures, infections, or tumors. It's painless and generally quick.

47 services47 patients

Ct scan of abdomen and pelvis without contrast 74176

A CT scan of the abdomen and pelvis is a non-invasive medical test. It uses special X-ray equipment to create detailed images of your abdominal and pelvic areas. This helps doctors examine organs, tissues, and vessels. No contrast dye is used in this procedure.

46 services46 patients

Mri scan of leg joint without contrast 73721

An MRI scan of your leg joint is a non-invasive procedure that uses magnetic fields and radio waves to create detailed images of the structures within your leg. This helps doctors diagnose or monitor conditions without using contrast dye.

44 services42 patients

Ct scan of blood vessels of head with contrast 70496

A CT scan of the head's blood vessels with contrast is a diagnostic procedure. A special dye (contrast) is injected into your body to make the blood vessels visible on the scan. This helps identify issues like blockages or abnormalities in your head's blood vessels.

41 services41 patients

Mri scan of brain without contrast 70551

An MRI scan of the brain without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to create detailed images of your brain. It helps in detecting abnormalities like tumors, stroke, inflammation, or infection.

41 services41 patients

Mri scan of brain before and after contrast 70553

An MRI scan of the brain, both before and after contrast, helps visualize different brain structures. Initially, images are taken without a contrast agent. Then, a safe dye is injected which helps highlight certain areas, providing clearer, more detailed images.

41 services41 patients

Ct scan of blood vessels of neck with contrast 70498

A CT scan of the neck's blood vessels with contrast is a diagnostic procedure. It uses X-rays and a special dye to create detailed images of your neck's blood vessels. This helps doctors detect issues such as blockages or abnormalities.

40 services40 patients

Ct scan of middle spine without contrast 72128

A CT scan of the middle spine without contrast is a non-invasive imaging test. It uses X-rays to create detailed pictures of your mid-spine area. This scan helps doctors identify issues like fractures, tumors, or infections. No dye is used in this procedure.

40 services40 patients

Nuclear medicine studies of heart muscle at rest and with stress and spect 78452

Nuclear medicine studies of the heart involve two parts: rest and stress. During rest, images are taken of your heart at ease. During stress, images are taken after exercise or medication-induced stress. SPECT is a special imaging technique providing 3D pictures of your heart, helping identify any issues.

40 services40 patients

Ultrasound study of arm or leg veins with compression and maneuvers 93970

An ultrasound study of arm or leg veins with compression and maneuvers is a non-invasive procedure that uses sound waves to create images of your veins. This helps identify blood clots or other vein problems. During the procedure, pressure is applied to the veins and certain movements are performed to assess blood flow.

35 services35 patients

Ct scan of chest without contrast 71250

A CT scan of the chest without contrast is a non-invasive imaging procedure. It uses special X-ray equipment to produce detailed images of your chest area, including your lungs and heart. It can help diagnose conditions such as lung diseases or heart disorders. It doesn't involve any dyes or contrast agents.

33 services33 patients

X-ray of hip, 2-3 views 73502

An X-ray of the hip with 2-3 views is a non-invasive imaging test. It uses a small amount of radiation to produce pictures of the hip joint. These images help in diagnosing conditions like fractures, arthritis, or other abnormalities. The process is quick and painless.

32 services31 patients

Ct scan of abdomen and pelvis with contrast 74177

32 services32 patients

Ct scan of chest without contrast 71250

30 services30 patients

X-ray of knee, 4 or more views 73564

An X-ray of the knee, 4 or more views, is a non-invasive imaging test. It involves capturing multiple images of your knee from different angles. This helps in diagnosing conditions such as fractures, arthritis, or infections. The procedure is quick and painless.

30 services20 patients

Imaging for evaluation of swallowing function 74230

This process, known as a swallowing study, uses imaging technology to view how food and liquid move from your mouth to your stomach. It helps identify any issues you may have swallowing, which can be crucial for determining the best treatment plan.

29 services29 patients

Nuclear medicine study of heart muscle at rest and with stress and spect 78451

A nuclear medicine study of the heart muscle, both at rest and under stress, along with SPECT, helps assess heart health. A safe radioactive substance is injected, which the heart absorbs. Then, a special camera captures images of the heart. This procedure can detect heart disease or other issues.

28 services28 patients

X-ray of pelvis, 1-2 views 72170

An X-ray of the pelvis, 1-2 views, is a quick and painless imaging test. It uses a small amount of radiation to produce images of the lower part of your torso. These images help to detect any abnormalities or injuries in your hip bones and surrounding structures.

26 services26 patients

Ultrasound study of one arm or leg veins with compression and maneuvers 93971

This is a non-invasive procedure using sound waves to visualize veins in an arm or leg. It involves applying gentle pressure and performing certain movements. It helps identify any abnormal blood flow or clots, ensuring vascular health.

25 services25 patients

Ct scan of chest with contrast 71260

A CT scan of the chest with contrast is an imaging procedure. A special dye (contrast) is used to highlight specific areas in your body, providing clearer pictures of your chest. This helps in diagnosing conditions related to your lungs, heart, and other chest structures.

24 services24 patients

Mri scan of arm joint without contrast 73221

An MRI scan of the arm joint is a non-invasive imaging procedure that uses magnetic fields and radio waves to create detailed images of the structures within your arm joint. No contrast dye is used in this process. It helps to diagnose or monitor conditions like arthritis, injuries, or infections.

24 services22 patients

Ct scan of blood vessels of chest with contrast 71275

A CT scan of the chest with contrast is a non-invasive imaging test. It uses X-rays and a special dye to get detailed images of your blood vessels in the chest. This helps in diagnosing conditions related to heart and lungs.

23 services23 patients

Mri scan of brain without contrast 70551

21 services21 patients

Mri scan of upper spinal canal without contrast 72141

An MRI scan of the upper spinal canal without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to create detailed images of your upper spine. This helps doctors identify issues such as injuries, infections or diseases. No dye is used.

21 services21 patients

Complete ultrasound scan behind abdominal cavity 76770

A complete ultrasound scan behind the abdominal cavity is a non-invasive imaging procedure. It uses sound waves to create pictures of the structures and organs located at the back of your abdomen. It helps in diagnosing health conditions and monitoring ongoing treatments.

21 services21 patients

X-ray of lower and sacral spine, 2-3 views 72100

An X-ray of the lower and sacral spine involves capturing images of your lower back area, including the tailbone. This procedure helps in identifying problems like fractures, infections, or deformities. 2-3 different angle views provide a comprehensive picture.

19 services19 patients

Mri scan of abdomen before and after contrast 74183

An MRI scan of the abdomen before and after contrast provides detailed images of your abdominal organs. Initially, images are taken without a contrast agent. Then, a safe dye is administered, usually via an IV, to highlight certain areas, giving a clearer picture to help diagnose various conditions.

19 services19 patients

Limited ultrasound scan of abdomen 76705

A limited ultrasound scan of the abdomen is a non-invasive imaging test. It uses sound waves to produce images of the abdominal organs such as the liver, gallbladder, spleen, pancreas, and kidneys. This helps to identify any abnormalities or issues.

19 services19 patients

Dxa bone density measurement of hip, pelvis, spine 77080

A DXA bone density measurement is a simple, quick, and non-invasive procedure that assesses the strength of your bones. This test uses X-rays to measure the amount of minerals, mainly calcium, in the hip, pelvis, and spine. It helps in early detection of osteoporosis or other bone diseases.

19 services19 patients

Ct scan of face without contrast 70486

A CT scan of the face without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your face, including bones, soft tissues, and blood vessels. It's often used to diagnose diseases, injuries, or abnormalities. No contrast dye is used in this procedure.

18 services18 patients

X-ray of knee, 3 views 73562

An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.

18 services16 patients

X-ray of shoulder, minimum of 2 views 73030

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

17 services16 patients

X-ray of shoulder, minimum of 2 views 73030

17 services15 patients

X-ray of hip, 2-3 views 73502

17 services14 patients

Ct scan of abdomen and pelvis without contrast 74176

17 services17 patients

3d radiographic procedure 76376

A 3D radiographic procedure is a non-invasive imaging test that helps doctors visualize the internal structures of your body in three dimensions. This advanced technology provides detailed images, aiding in accurate diagnosis and treatment planning. It involves exposure to minimal radiation.

17 services17 patients

X-ray of foot, minimum of 3 views 73630

An X-ray of the foot, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones and tissues in your foot. This helps to identify fractures, infections, or other abnormalities. Multiple views ensure a comprehensive examination.

16 services14 patients

Complete ultrasound scan behind abdominal cavity 76770

15 services15 patients

Ct scan head or brain without contrast 70450

14 services14 patients

X-ray of wrist, minimum of 3 views 73110

An X-ray of the wrist, minimum of 3 views, is a diagnostic procedure that uses radiation to create images of your wrist from different angles. This helps detect fractures, infections, or other abnormalities for accurate diagnosis and treatment planning.

14 services14 patients

X-ray of knee, 1-2 views 73560

An X-ray of the knee with 1-2 views is a quick, painless test that produces images of the knee bones. It helps identify fractures, infections, or changes in the knee joint. During the procedure, you'll be asked to stay still while the X-ray machine captures the images.

14 services14 patients

Complete ultrasound scan of abdomen 76700

A complete ultrasound scan of the abdomen is a non-invasive imaging procedure. It uses sound waves to produce images of the organs in your abdomen, such as the liver, gallbladder, spleen, pancreas, and kidneys. It helps in diagnosing, monitoring, and planning treatments.

14 services14 patients

Ct scan of chest with contrast 71260

13 services13 patients

Mri scan of pelvis without contrast 72195

An MRI scan of the pelvis without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to create detailed pictures of the lower part of your body. This helps doctors to identify any abnormalities or issues in that area.

13 services13 patients

Limited ultrasound scan of abdomen 76705

13 services13 patients

Nuclear medicine study whole body with ct scan 78816

A Nuclear Medicine Study with a CT Scan is a diagnostic procedure. It uses a small amount of radioactive substance and a CT scan to create detailed images of your body. These images help doctors diagnose, monitor, and treat various conditions.

13 services11 patients

Ct scan of leg without contrast 73700

A CT scan of the leg is a non-invasive imaging test that uses X-rays to capture detailed images of your leg's bones, muscles, and blood vessels. It doesn't use contrast dye and doesn't cause any pain. It helps in diagnosing injuries or diseases.

12 services12 patients

3d radiographic procedure with computerized image postprocessing 76377

A 3D radiographic procedure with computerized image postprocessing is a high-tech imaging test. It uses X-rays to create detailed 3D images of the body. The computerized postprocessing further enhances these images for more precise diagnosis and treatment planning.

12 services12 patients

Ct scan of lower spine without contrast 72131

11 services11 patients

Ct scan of leg without contrast 73700

11 services11 patients

Ultrasound scan of head and neck soft tissue 76536

An ultrasound scan of the head and neck soft tissue is a non-invasive procedure that uses sound waves to create images of the soft tissues in these areas. It helps identify any abnormalities or issues, such as tumors, cysts, or infections. It's painless and doesn't involve radiation.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92691 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$77.96 typical visit price

range $20.84 – $153.61

Typical copayment $19.49 (range $5.21 – $38.40)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Penry's NPI number?

The NPI number for Jackson Penry is 1003055401. It was assigned to this individual provider in the NPPES registry on February 10, 2009.

Where is Jackson Penry located?

Jackson Penry practices at 27700 Medical Center Road-Radiology Department, Mission Viejo, CA 92691. The listed phone number is (949) 364-7744.

What is Jackson Penry's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Is Jackson Penry enrolled in Medicare?

Yes. Jackson Penry is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Jackson Penry's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jackson Penry reassigns Medicare benefits to 13 organizations: Beverly Radiology Medical Group III (Anaheim, CA), North County Radiology Associates Inc (Escondido, CA), Cedars-Sinai Medical Care Foundation (Los Angeles, CA), San Diego Diagnostic Radiology Medical Group, Inc. (San Diego, CA), Ihs Radiology Medical Group, Inc. (San Diego, CA) and 8 more organizations, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jackson Penry's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jackson Penry was last updated on July 29, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.