Individual provider Active NPI

Michael J Gilewski, PHD

  • Clinical Neuropsychologist
  • Loma Linda, CA
National Provider Identifier
1811993389
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY 9194 Issued in CA
Practice address
11406 Loma Linda Dr RM 105
Loma Linda, CA 92354-3711
Phone
(909) 558-6220
Fax
(909) 558-6278
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging Psychologist 103TA0700X PSY 9194 CA
Rehabilitation Psychologist 103TR0400X PSY 9194 CA
Clinical Neuropsychologist 103G00000X PSY 9194 CA Primary

Addresses

Primary practice location

11406 Loma Linda Dr RM 105
Loma Linda, CA 92354-3711

Mailing address

11406 Loma Linda Dr RM 105
Loma Linda, CA 92354-3711
Phone (909) 558-6220

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060228000374 CA Practitioner - Clinical Psychologist 8426064478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

11406 Loma Linda Dr
Suite 300
Loma Linda, CA 92354-3711
Phone (909) 558-6277

File Number
Suite 54701
Los Angeles, CA 90074-4701

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY 9194CAMDAdult Development & Aging Psychologist
9194CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Clinical Neuropsychologist CurrentSince Oct 16, 2006 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Oct 16, 2006 Accepting new patients

Locations

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

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1811993389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR RM 105",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6220",
            "fax_number": "909-558-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR RM 105",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6220",
            "fax_number": "909-558-6278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILEWSKI",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY 9194",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "CA",
            "license": "PSY 9194",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY 9194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.