Individual provider Active NPI

Montri D Wongworawat, M.D.

  • Orthopaedic Hand Surgery Physician
  • Loma Linda, CA
National Provider Identifier
1235175035
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
A62977 Issued in CA
Practice address
11370 Anderson St
Suite 1500
Loma Linda, CA 92354-3450
Phone
(909) 558-2802
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X A62977 CA Primary

Addresses

Primary practice location

11370 Anderson St
Suite 1500
Loma Linda, CA 92354-3450

Mailing address

File Number 54701
Los Angeles, CA 90074-0001
Phone (909) 558-3111

Other identifiers 1

IdentifierTypeStateIssuer
00A629770MedicaidCA

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
I20091229000278 CA Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 8426198235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
Loma Linda University School of Medicine, 1996
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

Practice addresses (Care Compare)

11370 Anderson St
Loma Linda, CA 92354-3450

25455 Barton Rd
Loma Linda, CA 92354-3128
Phone (909) 558-2808

File Number
Suite 54701
Los Angeles, CA 90074-4701

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
A62977CAMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jun 17, 2012 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jun 17, 2012 Accepting new patients
Faculty Physicians and Surgeons of Llusm Hand Surgery Past Accepting new patients

Locations

900 E Washington St
Ste 200
Colton, CA 92324
Phone (909) 882-5867

25455 Barton Rd
Ste 102B
Loma Linda, CA 92354
Phone (909) 558-2808

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

25455 Barton Rd
Loma Linda, CA 92354
Phone (909) 558-2808

11370 Anderson St
Ste 1500
Loma Linda, CA 92354
Phone (909) 558-2802

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

28078 Baxter Rd
Murrieta, CA 92563
Phone (951) 290-4000

1686 Barton Rd
Redlands, CA 92373
Phone (909) 558-9200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mwongworawat12344@direct.llu.edu

Organizations & group practices 4

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": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1235175035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NUMBER 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "909-558-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11370 ANDERSON ST",
            "address_2": "SUITE 1500",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543450",
            "telephone_number": "909-558-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONGWORAWAT",
        "first_name": "MONTRI",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "CA",
            "license": "A62977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A629770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.