Ahmad Matin Rasul, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

102762 Issued in CA

Practice address

159 W Hospitality LN Ste 201
San Bernardino, CA 92408-3348

Phone

(909) 558-4960

NPI assigned

Jun 1, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1740804228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 W HOSPITALITY LN STE 201",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 W HOSPITALITY LN STE 201",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083348",
            "telephone_number": "909-558-4960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASUL",
        "first_name": "AHMAD MATIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-01",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "102762",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "102762",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Rashidi
• Jessica Racine Rasmussen
• Serehnaty Rasmussen
• Rasouli Medical Group
• Joseph Salinas Rastrollo, MD
• Annay Ratcliff
• Julie Rathbun, PH.D.
• Daniel Alec Ratica
• Caitlyn Ratliff
• Marshall Rattely

• Orthodontics and Dentofacial Orthopedics Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.