Centrelake Medical Group, Inc.
NPI 1629636006 · Diagnostic Radiology Physician · Chino, CA
Enrolled with Medicare as Part B Supplier - Independent Diagnostic Testing Facility (idtf) · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1629636006
- Entity type
- Organization
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tania Ceja, Manager(909) 242-7300
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
7 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
907 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| X-Ray of Chest, 2 Views71046 | 144 | $35 |
| Screening Mammography77067 | 124 | $133 |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine77080 | 118 | $41 |
| Complete Ultrasound Scan of Abdomen76700 | 75 | $122 |
| Complete Ultrasound Scan Behind Abdominal Cavity76770 | 56 | $114 |
| X-Ray of Knee, 1-2 Views73560 | 55 | $36 |
Practice location
Mailing address
Registry dates
- Enumerated
- 2019-05-31
- Last updated
- 2021-05-24
- Certified
- 2021-05-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.