KENNEWICK RADIOLOGY GROUP, PC
NPI 1114491479
Radiology - Diagnostic Radiology in San Marino, CA
About Kennewick Radiology Group, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENNEWICK RADIOLOGY GROUP, PC (NPI 1114491479) is a healthcare organization registered as a diagnostic radiology in San Marino, California and active in the NPI registry since January 2019. The organization lists Sandip Patidar, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kennewick Radiology Group, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Kennewick Radiology Group, PC, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Kennewick Radiology Group, PC's NPI number?
The NPI number for Kennewick Radiology Group, PC is 1114491479. It was assigned to this organization in the NPPES registry on January 18, 2019.
Where is Kennewick Radiology Group, PC located?
Kennewick Radiology Group, PC is located at 765 La Mirada Ave, San Marino, CA 91108. The listed phone number is (559) 455-4009.
What is Kennewick Radiology Group, PC's specialty?
The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.
Is Kennewick Radiology Group, PC enrolled in Medicare?
Yes. Kennewick Radiology Group, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kennewick Radiology Group, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Diagnostic Radiology, reassign their Medicare billing to Kennewick Radiology Group, PC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Kennewick Radiology Group, PC was last updated on January 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Kennewick Radiology Group, Pc · NPI 1114491479
Diagnostic Radiology organization in San Marino, California. Organization record, active in the CMS NPPES registry since January 18, 2019.
## Identity
- **NPI:** 1114491479 (Entity type: Organization)
- **Enumerated:** January 18, 2019
- **Primary specialty:** Radiology - Diagnostic Radiology · taxonomy 2085R0202X
- **Organization subpart:** No
- **Authorized official:** Sandip Patidar, OWNER
## Practice location
- **Address:** 765 LA MIRADA AVE, San Marino, CA 91108-1729
- **Phone:** (559) 455-4009
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians (Diagnostic Radiology) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 18, 2019
---
Source: [NPI Profile](https://npiprofile.com/npi/1114491479) · Data from the CMS NPPES public registry.