MODERN VASCULAR OF GLENDALE, LLC
NPI 1063947638
Radiology - Vascular & Interventional Radiology in Glendale, AZ
NPI Status: Active since April 20, 2017
Contact Information
11851 N 51ST AVE
BUILDING G
GLENDALE, AZ
ZIP 85304
Phone: (818) 949-2634
- Organization
- Radiology
- Vascular & Interventional Radiology
- CLIA Number: 03D2170990
- CLIA Cert. Type: Other - OUTPATIENT TREATMENT CENT
- CLIA Exp. Date: 08-09-2026
About MODERN VASCULAR OF GLENDALE, LLC
This page provides the complete NPI Profile along with additional information for Modern Vascular Of Glendale, Llc, a provider established in Glendale, Arizona operating as a Radiology, focusing in vascular & interventional radiology . The healthcare provider is registered in the NPI registry with number 1063947638 assigned on April 2017. The practitioner's primary taxonomy code is 2085R0204X. The provider is registered as an organization and their NPI record was last updated 8 years ago. Modern Vascular Of Glendale, Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Yury Gampel (Manager)
- NPI
- 1063947638
- Provider Name
- MODERN VASCULAR OF GLENDALE, LLC
- Entity Type
- Organization
- Location Address
- 11851 N 51ST AVE BUILDING G GLENDALE, AZ 85304
- Location Phone
- (818) 949-2634
- Mailing Address
- 26500 AGOURA RD STE 102-587 CALABASAS, CA 91302
- Mailing Phone
- (818) 880-8605
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-20-2017
- Last Update Date
- 07-11-2018
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Radiology Vascular & Interventional Radiology
- Taxonomy Code
- 2085R0204X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
| 2 | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 3 | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 4 | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D2170990
- Facility Type
- Other - OUTPATIENT TREATMENT CENT
- Certificate Effective Date
- August 10, 2024
- Certificate Expiration Date
- August 09, 2026
- Laboratory Director
- PATRICK E. DUFFY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Modern Vascular Of Glendale, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063947638, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 62. The final step is to find the difference between that total and the next multiple of ten (70 - 62 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 62 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063947638, enumerated as an "organization" on April 20, 2017.
The provider is located at 11851 N 51ST AVE BUILDING G GLENDALE, AZ 85304 and the phone number is (818) 949-2634.
Radiology with taxonomy code 2085R0204X and a focus in Vascular & Interventional Radiology.
