Kenneth Jutzy, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

G37876 Issued in CA

Practice address

11234 Anderson St
#1617
Loma Linda, CA 92354-2804

Phone

(909) 558-8591

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional CardiologyAlso: Cardiovascular Disease (Cardiology), Internal Medicine

Education

Loma Linda University School of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Sac Health SystemGroup PAC ID 4385533579, 222 clinicians

County of RiversideGroup PAC ID 6507754488, 190 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327
• Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (24 of 25)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kjutzy8158@direct.llu.edu

All facility ownership & control disclosures 64

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 77

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Adventist Health Clearlake Hospital Inc

  • Rural Health Clinic/Center
  • Lakeport, CA
  • NPI 1417027095

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc

  • Rural Health Clinic/Center
  • Hidden Valley Lake, CA
  • NPI 1558737486

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Critical Access Hospital
  • Clearlake, CA
  • NPI 1124018031

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Rural Health Clinic/Center
  • Corning, CA
  • NPI 1285054106

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Rural Health Clinic/Center
  • Clearlake, CA
  • NPI 1316937121

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Critical Access Hospital
  • Clearlake, CA
  • NPI 1487897047

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Rural Health Clinic/Center
  • Paradise, CA
  • NPI 1912092792

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Rural Health Clinic/Center
  • Kelseyville, CA
  • NPI 1962492876

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital Inc.

  • Rural Health Clinic/Center
  • Middletown, CA
  • NPI 1972593788

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital, Inc

  • Rural Health Clinic/Center
  • Lower Lake, CA
  • NPI 1841626587

  Corporate Director

  CMS ownership
• Adventist Health Clearlake Hospital, Inc

  • Rural Health Clinic/Center
  • Lakeport, CA
  • NPI 1871063040

  Corporate Director

  CMS ownership
• Adventist Health Delano

  • General Acute Care Hospital
  • Delano, CA
  • NPI 1144237272

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
  • NPI 1023122967
  Medicare reassignment Care Compare group NPD
• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Sac Health System

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1013935923
  Medicare reassignment Care Compare group NPD
• Beaver Medical Group P C

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment NPD
• Beaumont Radiology Services LLC

  • Radiology Clinic/Center
  • Beaumont, CA
  • NPI 1629212840
  NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Lake Elsinore, CA
  • NPI 1396859179
  NPD
• County of Riverside

  • Clinical Medical Laboratory
  • Riverside, CA
  • NPI 1952496010
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Moreno Valley, CA
  • NPI 1073563748
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Neurology Physician
  • Loma Linda, CA
  • NPI 1386694313
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331

  Cardiovascular Disease

  NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Highland, CA
  • NPI 1689624991
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• County of Riverside

  • General Acute Care Hospital
  • Moreno Valley, CA
  • NPI 1821159195
  Care Compare affiliation
• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271030400000",
    "number": "1073531802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-558-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "#1617",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUTZY",
        "first_name": "KENNETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2010-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G37876",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "G37876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G378760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yoona Jung
• Shawna Jurlina
• Just N Time Transportation LLC
• Gregory James Jutzy, M.D.
• Jessica Jutzy, MD
• Cameron Mohamad-Dean Juybari
• K. D. Macknet, M.D., Inc.
• Marissa Dolores Kachadoorian
• Avaish Kachhwaha, MBCHB
• Nikita Kadakia, MD

• Interventional Cardiology Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Interventional Cardiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.