Iwan Nyotowidjojo, MD in Rancho Santa Margarita, CA

Iwan Nyotowidjojo, MD is a medicare enrolled "Internal Medicine" physician in Rancho Santa Margarita, California. He went to University Of Vermont College Of Medicine and graduated in 2014 and has 10 years of diverse experience with area of expertise as Internal Medicine. He is a member of the group practice Memorialcare Medical Foundation, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa, Glutality Provider Group Pa and his current practice location is 29472 Avenida De Las Banderas, Rancho Santa Margarita, California. You can reach out to his office (for appointments etc.) via phone at (949) 459-9968.

Iwan Nyotowidjojo is licensed to practice in California (license number A90249) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1578976270.

Contact Information

	Iwan Nyotowidjojo, MD
	29472 Avenida De Las Banderas, Rancho Santa Margarita, CA 92688
	(949) 459-9968
	(949) 766-2565

Map and Direction

Physician's Profile

Full Name	Iwan Nyotowidjojo
Gender	Male
Speciality	Internal Medicine
Experience	10 Years
Location	29472 Avenida De Las Banderas, Rancho Santa Margarita, California
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Iwan Nyotowidjojo attended and graduated from University Of Vermont College Of Medicine in 2014

NPI Data:

NPI Number: 1578976270
Provider Enumeration Date: 06/10/2014
Last Update Date: 04/14/2023

Medicare PECOS Information:

PECOS PAC ID: 3274859970
Enrollment ID: I20200423002440

Medical Identifiers

Medical identifiers for Iwan Nyotowidjojo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1578976270	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207R00000X	Internal Medicine	45679 (Alabama)	Secondary
207R00000X	Internal Medicine	68913 (Arizona)	Secondary
207R00000X	Internal Medicine	DR.0069772 (Colorado)	Secondary
207R00000X	Internal Medicine	R74508 (Arizona)	Secondary
207R00000X	Internal Medicine	CL-0025782 (Delaware)	Secondary
207R00000X	Internal Medicine	TPME4194 (Florida)	Secondary
207R00000X	Internal Medicine	MD-50889 (Iowa)	Secondary
207R00000X	Internal Medicine	MC-1884 (Idaho)	Secondary
207R00000X	Internal Medicine	01089040A (Indiana)	Secondary
207R00000X	Internal Medicine	TW-00242 (Kansas)	Secondary
207R00000X	Internal Medicine	C1300 (Kentucky)	Secondary
207R00000X	Internal Medicine	334744 (Louisiana)	Secondary
207R00000X	Internal Medicine	D0096206 (Maryland)	Secondary
207R00000X	Internal Medicine	MD26749 (Maine)	Secondary
207R00000X	Internal Medicine	A90249 (California)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Memorialcare Saddleback Medical Center	Laguna hills, CA	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Memorialcare Medical Foundation	8729277314	382
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25
Glutality Provider Group Pa	9032549837	25

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Iwan Nyotowidjojo allows following entities to bill medicare on his behalf.

Entity Name	Riverside Medical Clinic Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1720183403 PECOS PAC ID: 2961492327 Enrollment ID: O20040517000880

Entity Name	Senior Care Medical Associates Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1790909042 PECOS PAC ID: 5294790929 Enrollment ID: O20070810000384

Entity Name	Memorialcare Medical Foundation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1205167350 PECOS PAC ID: 8729277314 Enrollment ID: O20110113000219

Entity Name	Signify Health Medical Associates Of California Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1124685169 PECOS PAC ID: 8325370570 Enrollment ID: O20191022000320

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Iwan Nyotowidjojo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Iwan Nyotowidjojo, MD 29472 Avenida De Las Banderas, Rancho Santa Margarita, CA 92688 Ph: (949) 459-9968	Iwan Nyotowidjojo, MD 29472 Avenida De Las Banderas, Rancho Santa Margarita, CA 92688 Ph: (949) 459-9968

Reviews and Comments

Internal Medicine Doctors in Rancho Santa Margarita, CA

Dr. Yolanda P Gomez, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 22342 Avenida Empresa, Suite 195, Rancho Santa Margarita, CA 92688 Phone: 949-713-9705 Fax: 949-858-3826
Siamak Zamani, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 29873 Santa Margarita Pkwy, Ste 100, Rancho Santa Margarita, CA 92688 Phone: 949-589-9114 Fax: 949-421-0763
Susanna Yu Tan, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1 Legacy Way, Rancho Santa Margarita, CA 92688 Phone: 626-319-8791
Dr. Gwendolyn S Gore, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 29472 Ave De Las Banderas, Rancho Santa Margarita, CA 92688 Phone: 949-459-9968 Fax: 949-766-2565
Dr. Shaparak Kamarei, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 29873 Santa Margarita Pkwy 100, Rancho Santa Margarita, CA 92688 Phone: 949-709-0988 Fax: 949-709-8377

Iwan Nyotowidjojo, MD - Medicare Internal Medicine in Rancho Santa Margarita, CA