NPIMap

Organization Active NPI

Loma Linda University Cardiology Medical Group, Inc.

  • Cardiovascular Disease Physician
  • Loma Linda, CA
National Provider Identifier
1316997596
Registry record updated Aug 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
LOMA LINDA UNIVERSITY CARDIOLOGY MEDICAL GROUP, INC.
Practice address
11234 Anderson St
Loma Linda, CA 92354-2804
Phone
(909) 558-4200
Fax
(909) 558-7975
NPI assigned
May 11, 2006
Last updated
Aug 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2007

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

Authorized official

Name
Kenneth Jutzy, M.D.NPI 1073531802
Title
President
Phone
(909) 558-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

11234 Anderson St
Loma Linda, CA 92354-2804

Mailing address

PO Box 10427
San Bernardino, CA 92423-0427
Phone (909) 558-8591

Other identifiers 1

IdentifierTypeStateIssuer
GR0042260MedicaidCA

National Provider Directory

National Provider Directory

Locations

11234 Anderson St
#1617
Loma Linda, CA 92350
Phone (909) 558-4200

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188432000000",
    "number": "1316997596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10427",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924230427",
            "telephone_number": "909-558-8591",
            "fax_number": "909-558-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4200",
            "fax_number": "909-558-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOMA LINDA UNIVERSITY CARDIOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-08-30",
        "status": "A",
        "authorized_official_last_name": "JUTZY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-558-4200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0042260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.