Individual provider Active NPI

Michael Eugene Wettstein, MD

  • Pain Medicine (Anesthesiology) Physician
  • Loma Linda, CA
National Provider Identifier
1245271303
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
A67921 Issued in CA
Practice address
11406 Loma Linda Dr Ste 516
Loma Linda, CA 92354-3711
Phone
(909) 558-6204
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X A67921 CA Primary

Addresses

Primary practice location

11406 Loma Linda Dr Ste 516
Loma Linda, CA 92354-3711

Mailing address

11406 Loma Linda Dr Ste 516
Loma Linda, CA 92354-3711
Phone (909) 558-6204

Other identifiers 1

IdentifierTypeStateIssuer
P00415474OtherWARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101123001085 OR Practitioner - Interventional Pain ManagementPractitioner - AnesthesiologyPractitioner - Pain Management 3779676432 Reassigns benefits to 2 organizations
I20210510001970 CA Practitioner - Pain Management 3779676432 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A67921CAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oregon Spine and Sports, LLC CurrentSince Jul 1, 2019 Accepting new patients
Bend Memorial Clinic PC CurrentSince Mar 1, 2020 Accepting new patients
Faculty Physicians and Surgeons of Llusm Anesthesiology CurrentSince Jun 16, 2021 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Bend Memorial Clinic PC CurrentSince Mar 1, 2020 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jun 16, 2021 Accepting new patients
Bend Anesthesiology Group, PC Anesthesiology Past Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

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

11406 Loma Linda Dr
Ste 300
Loma Linda, CA 92354
Phone (909) 558-6277

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

1501 NE Medical Center Dr
Bend, OR 97701
Phone (541) 317-4354

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

2115 NE Wyatt Ct
Ste 101
Bend, OR 97701
Phone (541) 318-0124

Interoperability endpoints

  • Direct secure messaging: mwettstein75310@direct.llu.edu
  • FHIR API: https://fhir4.healow.com/fhir/r4/GGIJBD
  • Direct secure messaging: michael.wettstein.p2@direct.hvvmg.nextgenshare.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1245271303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR STE 516",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR STE 516",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETTSTEIN",
        "first_name": "MICHAEL",
        "middle_name": "EUGENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A67921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00415474",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.