Individual provider Active NPI

Jeffrey Luther, M.D.

  • Adult Medicine Physician
  • Long Beach, CA
National Provider Identifier
1750487591
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
G66587 Issued in CA
Practice address
450 E Spring St
Suite #1
Long Beach, CA 90806-1625
Phone
(562) 933-0068
Fax
(562) 933-0078
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Family Medicine) Physician 207QA0000X G66587 CA
Adult Medicine Physician 207QA0505X G66587 CA Primary

Addresses

Primary practice location

450 E Spring St
Suite #1
Long Beach, CA 90806-1625

Mailing address

17360 Brookhurst St
Attn: MCMF- Credentialing Department
Fountain Valley, CA 92708-3720

Other identifiers 1

IdentifierTypeStateIssuer
00G665870MedicaidCA

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
I20110214000554 CA Practitioner - Family Practice 6507046125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Irvine, California College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

450 E Spring St
Suite 1
Long Beach, CA 90806-1625
Phone (562) 933-0050

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G66587CAMDAdolescent Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation CurrentSince Mar 15, 2011 Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Bristol Park Medical Group, Inc Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

450 E Spring St
Ste 1
Long Beach, CA 90806
Phone (562) 933-0050

Interoperability endpoints

  • Direct secure messaging: jluther15871@direct.memorialcare.org

Organizations & group practices 4

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 1

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1750487591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "address_2": "ATTN: MCMF- CREDENTIALING DEPARTMENT",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E SPRING ST",
            "address_2": "SUITE #1",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061625",
            "telephone_number": "562-933-0068",
            "fax_number": "562-933-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTHER",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "CA",
            "license": "G66587",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "G66587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G665870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.