| Jay Kenneth Mattheis, MD | |
|
11370 Anderson St Ste 1800, Loma Linda, CA 92354-3450 | |
| (909) 558-2154 | |
| (909) 558-2180 |
| Full Name | Jay Kenneth Mattheis |
|---|---|
| Gender | Male |
| Speciality | Ophthalmology |
| Location | 11370 Anderson St Ste 1800, Loma Linda, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154311058 | NPI | - | NPPES |
| 100527518 | Medicaid | NV | |
| P01074697 | Other | NV | RR MEDICARE PTAN |
| 1801843685 | Other | NV | GROUP NPI# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207W00000X | Ophthalmology | ME56477 (Florida) | Secondary |
| 207W00000X | Ophthalmology | 14270 (Nevada) | Secondary |
| 207W00000X | Ophthalmology | G66270 (California) | Primary |
| Entity Name | Faculty Physicians And Surgeons Of Llusm |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205009917 PECOS PAC ID: 1153227814 Enrollment ID: O20031211000981 |
| Entity Name | Sac Health System |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013935923 PECOS PAC ID: 4385533579 Enrollment ID: O20040315000608 |
| Mailing Address | Practice Location Address |
|---|---|
| Jay Kenneth Mattheis, MD 11370 Anderson St Ste 1800, Loma Linda, CA 92354-3450 Ph: (909) 558-2154 | Jay Kenneth Mattheis, MD 11370 Anderson St Ste 1800, Loma Linda, CA 92354-3450 Ph: (909) 558-2154 |
Amr Azzam, MD, PHD Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 11234 Anderson St, Loma Linda, CA 92350 Phone: 909-558-2182 | |
Dr. Philip Harold Wallar, M.D. Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 11201 Benton St, Loma Linda, CA 92357 Phone: 909-583-6067 Fax: 999-777-3291 | |
David Sierpina, MD Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 11234 Anderson St, Gme Office Csp 21005, Loma Linda, CA 92354 Phone: 909-558-2154 Fax: 909-558-2180 | |
Priyal Shah, MD Ophthalmology Medicare: Medicare Enrolled Practice Location: 11370 Anderson St Ste 1800, Loma Linda, CA 92354 Phone: 909-558-2154 | |
Dr. Ritesh Gupta, MD Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 11370 Anderson St Ste 1800, Loma Linda, CA 92354 Phone: 909-558-2154 Fax: 909-558-2180 | |
Howard Guan, M.D. Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 11370 Anderson St, Suite 1800, Loma Linda, CA 92354 Phone: 909-558-2154 | |
Donald E Shearer, M.D. Ophthalmology Medicare: Medicare Enrolled Practice Location: 11346 Mountain View Ave, Ste B, Loma Linda, CA 92354 Phone: 909-796-0101 Fax: 909-796-3035 |