Active NPI
Matthew J Lotysch, M.D.
- Neuroradiology Physician
- Inglewood, CA
National Provider Identifier
1710032370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- G39962
- Practice address
- 555 E Hardy St
Inglewood, CA 90301-4011 - Phone
- (310) 673-4660
- NPI assigned
- Jan 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | G39962 | CA | Primary |
Addresses
Primary practice location
555 E Hardy St
Inglewood, CA 90301-4011
Mailing address
PO Box 5686
Orange, CA 92863-5686
Phone (888) 598-8819
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G399620 | Other | BLUE SHIELD OF CA | |
| 00G399620E02 | Other | CALOPTIMA | |
| 00G399620 | Medicaid | CA | |
| P00407406 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G39962 | CA | MD | Neuroradiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centinela Radiology Medical Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Diagnostic Radiology Physician
- Inglewood, CA
- NPI 1861475352
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1710032370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5686",
"city": "ORANGE",
"state": "CA",
"postal_code": "928635686",
"telephone_number": "888-598-8819",
"fax_number": "714-571-5055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 E HARDY ST",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903014011",
"telephone_number": "310-673-4660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOTYSCH",
"first_name": "MATTHEW",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-24",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "CA",
"license": "G39962",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CA",
"identifier": "00G399620",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALOPTIMA",
"identifier": "00G399620E02",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G399620",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00407406",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
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- Mark Lott, M.D.
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- Erminthe Louis Charles, PHARMD
- Love Home Inc.
- Selena Michelle Love
- Zina Love
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.