Individual provider Active NPI

Brian J. Wolk, MD

  • Emergency Medicine Physician
  • Loma Linda, CA
National Provider Identifier
1215134358
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A119990 Issued in CA
Practice address
11234 Anderson St
MC-A890
Loma Linda, CA 92354-2804
Phone
(909) 558-7171
Fax
(909) 558-0793
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Toxicology (Emergency Medicine) Physician 207PT0002X A119990 CA
Emergency Medicine Physician 207P00000X A119990 CA Primary

Addresses

Primary practice location

11234 Anderson St
MC-A890
Loma Linda, CA 92354-2804

Mailing address

11234 Anderson St
MC-A890
Loma Linda, CA 92354-2804
Phone (909) 558-7171

Other identifiers 1

IdentifierTypeStateIssuer
110083818AMedicaidMA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120627000731 CA Practitioner - Emergency Medicine 1951440700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Tufts University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

328 Commercial Rd
Suite 101
San Bernardino, CA 92408-3766
Phone (909) 558-6222

Hospital & facility affiliations

  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A119990CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Family Medicine CurrentSince Jan 1, 2014 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Emergency Medicine CurrentSince Jan 1, 2014 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Umass Memorial Medical Center, Inc. Past Accepting new patients

Locations

11234 Anderson St
#890
Loma Linda, CA 92350
Phone (909) 558-7171

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

11234 Anderson St
Ste 1405
Loma Linda, CA 92350
Phone (909) 558-4252

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

328 Commercial Rd
Ste 101
San Bernardino, CA 92408
Phone (909) 558-6222

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1215134358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "MC-A890",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-7171",
            "fax_number": "909-558-0793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "MC-A890",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-7171",
            "fax_number": "909-558-0793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLK",
        "first_name": "BRIAN",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PT0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Medical Toxicology",
            "state": "CA",
            "license": "A119990",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A119990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110083818A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.