Individual provider Active NPI

Jack Stephen Creagmile, MD

  • Glaucoma Specialist (Ophthalmology) Physician
  • Loma Linda, CA
National Provider Identifier
1659909497
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Glaucoma Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0009X
License
A193595 Issued in CA
Practice address
11370 Anderson St # 1800
Loma Linda, CA 92354-3450
Phone
(909) 558-2154
NPI assigned
Mar 28, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A193595 CA
Glaucoma Specialist (Ophthalmology) Physician 207WX0009X A193595 CA Primary

Addresses

Primary practice location

11370 Anderson St # 1800
Loma Linda, CA 92354-3450

Mailing address

11370 Anderson St # 1800
Loma Linda, CA 92354-3450
Phone (909) 558-2154

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
I20240607001649 CA Practitioner - Ophthalmology 3173065943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Rush Medical College of Rush University, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

11370 Anderson St
Loma Linda, CA 92354-3450

26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (951) 486-4000

4244 Riverwalk Pkwy
Suite 100
Riverside, CA 92505-3372
Phone (909) 558-2154

81 Highland Springs Ave
Beaumont, CA 92223-3170
Phone (909) 558-4000

8599 Haven Ave
Suite 102And210
Rancho Cucamonga, CA 91730-4849
Phone (909) 558-2806

File Number
Suite 54701
Los Angeles, CA 90074-4701

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery54

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A193595CAMDGlaucoma Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 1, 2025 Accepting new patients
Regents of the University of California Ophthalmology CurrentSince Jul 8, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Ophthalmology Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 1, 2025 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

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

850 Health Sciences Rd
Irvine, CA 92617
Phone (949) 824-0606

11370 Anderson St
#1800
Loma Linda, CA 92354
Phone (909) 558-2154

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

11370 Anderson St
Ste 1800
Loma Linda, CA 92354
Phone (909) 558-2154

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

26520 Cactus Ave
Ste 2021
Moreno Valley, CA 92555
Phone (951) 486-5700

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

4244 Riverwalk Pkwy
Ste 100
Riverside, CA 92505
Phone (909) 558-2154

2195 Club Center Dr
Ste A
Sn Bernrdno, CA 92408
Phone (909) 835-1750

Interoperability endpoints

  • Direct secure messaging: jcreagmile1262010@direct.llu.edu

Organizations & group practices 6

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 2

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": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1659909497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11370 ANDERSON ST # 1800",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543450",
            "telephone_number": "909-558-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11370 ANDERSON ST # 1800",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543450",
            "telephone_number": "909-558-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREAGMILE",
        "first_name": "JACK",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-28",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A193595",
            "primary": false
        },
        {
            "code": "207WX0009X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Glaucoma Specialist",
            "state": "CA",
            "license": "A193595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.