Matthew Hadilaksono, DO

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

20A15470 Issued in CA

Practice address

1105 Las Tablas Rd Ste D
Templeton, CA 93465-9731

Phone

(805) 550-6689

Fax

(833) 615-2271

NPI assigned

Jan 15, 2015

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

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

Physical Medicine and RehabilitationAlso: Osteopathic Manipulative Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Restorative Spine and Pain IncGroup PAC ID 8426451428, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Coast Home Health Inc Home health agency, San Luis Obispo, CA, CCN 059010
• Marian Regional Medical Center Hospital, Santa Maria, CA, CCN 050107
• French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232

Merit-based Incentive Payment System (MIPS)

Final score

90.58 of 100Reported as individual

Quality

83.9

Promoting interoperability

93

Improvement activities

40

Cost

73.86

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24466/brand/1/csg/1/fhir/r4
• Direct secure messaging: matthew.hadilaksono.1@24466.direct.athenahealth.com

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.

• Restorative Spine and Pain, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Templeton, CA
  • NPI 1588234447
  Medicare reassignment Care Compare group NPD Authorized official
• Integrative Sports and Spine Inc

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Irvine, CA
  • NPI 1245630557
  Medicare reassignment NPD
• Lags Spine and Sportscare Medical Centers, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Hayward, CA
  • NPI 1962983965
  NPD (past)
• Regenerative Spine, Pain, and Neuropathy Centers, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Bakersfield, CA
  • NPI 1497323570
  NPD (past)

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

• Central Coast Home Health Inc

  • Home Health Agency
  • San Luis Obispo, CA
  • NPI 1609044924
  Care Compare affiliation
• Dignity Community Care

  dba French Hospital Medical Center

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1881760452
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Santa Maria, CA
  • NPI 1760510937
  Care Compare affiliation

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1205225174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 LA COLIMA",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492841",
            "telephone_number": "310-500-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 LAS TABLAS RD STE D",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659731",
            "telephone_number": "805-550-6689",
            "fax_number": "833-615-2271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 S Stratford Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Maria",
            "state": "CA",
            "postal_code": "934545902",
            "country_code": "US",
            "telephone_number": "805-550-6689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HADILAKSONO",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-15",
        "last_updated": "2022-03-01",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "20A15470",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "20A15470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Greenman, NP
• Dianne Gross-Giese, OTRL,CHT
• Mark Richard Gruidl, NP
• Heather Guthrie-Knowles, LMFT
• Zaid Muhannad Haddadin, MD
• Thomas Hale, MD
• Julie Dawes Halverson, SLP-CCC, M.A.
• David Brent Hammer, PT
• Lindsay Diane Hanna, NP
• George R Hansen, MD

• Physical Medicine & Rehabilitation Physician in Templeton, CA
• Providers in Templeton, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.