NPIMap

Individual provider Active NPI

Harry Berj Matossian, M.D.

  • Gastroenterology Physician
  • Ukiah, CA
National Provider Identifier
1316945702
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
G62323 Issued in CA
Practice address
234 Hospital Dr
Ukiah, CA 95482-4560
Phone
(707) 462-0681
Fax
(707) 462-4647
NPI assigned
Jul 11, 2005
Reactivated
Mar 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X G62323 CA Primary

Addresses

Primary practice location

234 Hospital Dr
Ukiah, CA 95482-4560

Mailing address

234 Hospital Dr
Ukiah, CA 95482-4560
Phone (707) 462-0681

Other practice location 1

100 Hospital Dr
Suite 201
Ketchum, ID 83340
Phone (208) 727-8888

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ56549ZOtherCABLUE SHIELD OF CALIFORNIA
00G623230MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100827000676 CA Practitioner - Gastroenterology 3375430564 Reassigns benefits to 3 organizations
I20240906002475 ID Practitioner - Gastroenterology 3375430564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic - Wood River LLCGroup PAC ID 3173783818, 66 clinicians
Sonora Community HospitalGroup PAC ID 4284538505, shared by 10 NPIs, 134 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Ketchum, ID 83340

100 Hospital Dr
Ketchum, ID 83340-9998

191 5TH St W
Ketchum, ID 83340-9998
Phone (208) 725-2171

193 Fairview LN
Sonora, CA 95370-4828
Phone (209) 536-5100

680 Guzzi LN
Suite 206
Sonora, CA 95370-5288
Phone (209) 536-5760

Hospital & facility affiliations

  • St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323
  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335

Merit-based Incentive Payment System (MIPS)

Final score
89.83 of 100Reported as group
Quality
82.73
Promoting interoperability
100
Improvement activities
40
Cost
83.38

Merit-based Incentive Payment System (MIPS)

Final score
86.05 of 100Reported as group
Quality
91.8
Promoting interoperability
100
Improvement activities
40
Cost
61.7

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy165
Upper gastrointestinal (GI) endoscopy for acid reflux123

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital Internal Medicine CurrentSince Jan 1, 2025 Accepting new patients
Observatory Surgery Center LLC. Current Accepting new patients
Enloe Medical Center CurrentSince Jun 10, 2024 Accepting new patients
Sonora Community Hospital CurrentSince Jan 1, 2025 Accepting new patients
Sonora Community Hospital Current Accepting new patients
Sonora Community Hospital Current Accepting new patients
Sonora Community Hospital CurrentSince Feb 28, 2025 Accepting new patients
Enloe Medical Center Gastroenterology CurrentSince Jun 10, 2024 Accepting new patients
St Lukes Clinic - Wood River LLC Internal Medicine CurrentSince Aug 15, 2024 Accepting new patients
Sonora Community Hospital Past Accepting new patients

Locations

111 Raley Blvd
Ste 100
Chico, CA 95928
Phone (530) 332-3986

1390 E Lassen Ave
Chico, CA 95973
Phone (530) 332-6332

193 Fairview Ln
Ste C
Sonora, CA 95370
Phone (209) 532-3124

193 Fairview Ln
Sonora, CA 95370
Phone (209) 536-5100

680 Guzzi Ln
Ste 105
Sonora, CA 95370
Phone (209) 532-0126

193 Fairview Ln
Ste B
Sonora, CA 95370
Phone (209) 532-5100

680 Guzzi Ln
Ste 206
Sonora, CA 95370
Phone (209) 536-5760

Organizations & group practices 10

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1316945702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 HOSPITAL DR",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824560",
            "telephone_number": "707-462-0681",
            "fax_number": "707-462-4647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 HOSPITAL DR",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824560",
            "telephone_number": "707-462-0681",
            "fax_number": "707-462-4647"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hospital Dr",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Ketchum",
            "state": "ID",
            "postal_code": "83340",
            "country_code": "US",
            "telephone_number": "208-727-8888",
            "fax_number": "208-727-8889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATOSSIAN",
        "first_name": "HARRY",
        "middle_name": "BERJ",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-22",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "G62323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ56549Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G623230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.