Bryan Martin Wick, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A95308 Issued in CA

Practice address

11374 Mountain View Ave
Dover Building, Suite C
Loma Linda, CA 92354-3815

Phone

(909) 558-6094

NPI assigned

May 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Psychiatry

Education

University of Kansas School of Med (KC/Wich/Sal), 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy MD Medical Group IncGroup PAC ID 0446619738, 12 clinicians

Cep America - Psychiatry PCGroup PAC ID 0244522159, 93 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arrowhead Regional Medical Center Hospital, Colton, CA, CCN 050245

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bryan.wick.p1@direct.sokya.nextgenshare.com
• Direct secure messaging: bwick12242@direct.llu.edu

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.

• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Santa Maria, CA
  • NPI 1538757232
  Medicare reassignment Care Compare group NPD
• Legacy MD Medical Group Inc

  • General Practice Physician
  • El Centro, CA
  • NPI 1073210753
  Medicare reassignment Care Compare group NPD
• Crestline Psychiatry

  • Psychiatry Physician
  • Loma Linda, CA
  • NPI 1023954823
  NPD Authorized official
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Indio, CA
  • NPI 1144195926
  NPD
• Cep America - Psychiatry PC

  • Psychiatry Physician
  • Colton, CA
  • NPI 1306408000
  NPD

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

• County of San Bernardino

  • General Acute Care Hospital
  • Colton, CA
  • NPI 1720158009
  Care Compare affiliation

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1700099611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25654 LANE ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11374 MOUNTAIN VIEW AVE",
            "address_2": "DOVER BUILDING, SUITE C",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543815",
            "telephone_number": "909-558-6094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICK",
        "first_name": "BRYAN",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A95308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Colleen Ann Whitt, BS, RDH
• John Mervyn Whittaker, D.D.S.
• Nicole Kaye Whittle, AU.D., CCC-A
• Adwoa Oforiwaa Wiafe, MD
• Donna Jean Wical, OTR/L
• Cham Roeun Wick
• Lori Rene Wicker, PH.D.
• Thomas James Wiedemann, MPH, MTS
• Darren Wijaya
• Steffanie Wilamart, O.D.

• Psychiatry Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.