Dr Lusiana Kartawidjaja, MD in San Bernardino, CA

Dr Lusiana Kartawidjaja, MD is a medicare enrolled "Family Medicine" physician in San Bernardino, California. She graduated from medical school in 2002 and has 22 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Southern California Permanente Medical Group and her current practice location is 1717 E Date Pl, San Bernardino, California. You can reach out to her office (for appointments etc.) via phone at (888) 750-0036.

Dr Lusiana Kartawidjaja is licensed to practice in California (license number A105710) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1952536625.

Contact Information

	Dr Lusiana Kartawidjaja, MD
	1717 E Date Pl, San Bernardino, CA 92404-4428
	(888) 750-0036
	Not Available

Map and Direction

Physician's Profile

Full Name	Dr Lusiana Kartawidjaja
Gender	Female
Speciality	Family Practice
Experience	22 Years
Location	1717 E Date Pl, San Bernardino, California
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Dr Lusiana Kartawidjaja graduated from medical school in 2002

NPI Data:

NPI Number: 1952536625
Provider Enumeration Date: 05/23/2009
Last Update Date: 12/02/2021

Medicare PECOS Information:

PECOS PAC ID: 1254461833
Enrollment ID: I20100608000407

Medical Identifiers

Medical identifiers for Dr Lusiana Kartawidjaja such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1952536625	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	A105710 (California)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Southern California Permanente Medical Group	6002729175	7951

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. Dr Lusiana Kartawidjaja allows following entities to bill medicare on her behalf.

Entity Name	Southern California Permanente Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1316979834 PECOS PAC ID: 6002729175 Enrollment ID: O20040126000823

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. Dr Lusiana Kartawidjaja 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
Dr Lusiana Kartawidjaja, MD 1717 E Date Pl, San Bernardino, CA 92404-4428 Ph: (888) 750-0036	Dr Lusiana Kartawidjaja, MD 1717 E Date Pl, San Bernardino, CA 92404-4428 Ph: (888) 750-0036

Reviews and Comments

Family Medicine Doctors in San Bernardino, CA

Robert William Watrous, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 250 S G St, San Bernardino, CA 92410 Phone: 909-382-7100
Dr. Jesse R. Devera, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 303 E Vanderbilt Way, San Bernardino, CA 92415 Phone: 909-388-0810 Fax: 909-890-2081
Dr. Donna Ruth Thompson, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1700 North Waterman Ave, San Bernardino, CA 92404 Phone: 909-883-8611 Fax: 909-886-1798
Dr. Kelsey Louaine Cherepuschak, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 250 S G St, San Bernardino, CA 92410 Phone: 909-382-7100
Sachin Kumar Chatta, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 742 W Highland Ave, San Bernardino, CA 92405 Phone: 909-881-7320 Fax: 909-881-7330
Dr. Uzair Siddiqui, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 665 N D St, San Bernardino, CA 92401 Phone: 909-708-8158
Hugo A. Leon, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 250 S G St, San Bernardino, CA 92410 Phone: 909-382-7100 Fax: 909-382-7101

Dr Lusiana Kartawidjaja, MD - Medicare Family Practice in San Bernardino, CA