Organization Active NPI

George M. Jayatilaka, MD Inc

  • Legal Medicine
  • Long Beach, CA
National Provider Identifier
1437325404
Registry record updated Jan 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
Legal business name
GEORGE M. JAYATILAKA, MD INC
Practice address
1045 Atlantic Ave
Suite 818
Long Beach, CA 90813-3408
Phone
(562) 436-8117
Fax
(562) 432-2777
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2014

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

Authorized official

Name
Maria Samala
Title
Business Manager
Phone
(562) 436-8117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X Primary

Addresses

Primary practice location

1045 Atlantic Ave
Suite 818
Long Beach, CA 90813-3408

Mailing address

1045 Atlantic Ave
Suite 818
Long Beach, CA 90813-3408
Phone (562) 436-8117

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ78614ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090127000730 CA Part B Supplier - Clinic/Group Practice 5799849253 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Long Beach, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0683982George M Jayatilaka MD1045 Atlantic Avenue 818, Long Beach, CA 90813Certificate of waiverMar 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
George M Jayatilaka MD Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1437325404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "SUITE 818",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133408",
            "telephone_number": "562-436-8117",
            "fax_number": "562-432-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "SUITE 818",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133408",
            "telephone_number": "562-436-8117",
            "fax_number": "562-432-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE M. JAYATILAKA, MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "SAMALA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "562-436-8117"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ78614Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.