Wyatt Ryan Colloty, PA-C
Individual provider Active NPI Physician Assistant · Colton, CA
NPI 1093685372 · NPPES record last updated Feb 19, 2026
Key facts
- NPI
- 1093685372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 400 N Pepper Ave
Colton, CA 92324-1801 - Phone
- (909) 580-1378
- NPI assigned
- Nov 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 10
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Bernardino Medical Orthopaedic Group Inc
Practice addresses (Care Compare)
400 N Pepper Ave
Arrowhead
Colton, CA 92324-1801
Phone (909) 580-3390
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260416002287 | CA | Practitioner - Physician Assistant | 1052887189 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
400 N Pepper Ave
Colton, CA 92324-1801
Mailing address
400 N Pepper Ave
Colton, CA 92324-1801
Other providers in Colton, CA
- Ryan Andrew Cleary
- Melissa Dean Cline
- Lester Colegado
- Tatanasha Yvonne Coleman
- Elizabeth Colin
- Colton Clinica Medica Familiar a Medical Corporation
- Colton Dental & Orthodontics Dr Zaghi Dental Group PC
- Colton Dental Group
- Colton Valley Medical Care Inc
- Colton Valley Medical Group
All providers in Colton, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.