Active NPI
Darryl G Heustis, M.D.
- Cytopathology Physician
- Loma Linda, CA
National Provider Identifier
1841210382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cytopathology Physician
- License
- G29068
- Practice address
- 11370 Anderson St
Ste 2960
Loma Linda, CA 92354-3450 - Phone
- (909) 558-6422
- NPI assigned
- Jul 20, 2006
- Last updated
- Jul 16, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | G29068 | CA | Primary |
| Anatomic Pathology Physician | 207ZP0101X | G29068 | CA |
Addresses
Primary practice location
11370 Anderson St
Ste 2960
Loma Linda, CA 92354-3450
Mailing address
PO Box 1740
Loma Linda, CA 92354-0240
Phone (909) 558-6422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G290680 | Medicaid | CA |
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 |
|---|---|---|---|
| G29068 | CA | MD | Anatomic Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loma Linda University Medical Center | Past | Accepting new patients | |
| Loma Linda University Children's Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Children's Hospital
- Loma Linda, CA
- NPI 1366866345
-
- General Acute Care Hospital
- Loma Linda, CA
- NPI 1194731935
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1841210382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1740",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923540240",
"telephone_number": "909-558-6422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11370 ANDERSON ST",
"address_2": "STE 2960",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543450",
"telephone_number": "909-558-6422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEUSTIS",
"first_name": "DARRYL",
"middle_name": "G",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "CA",
"license": "G29068",
"primary": true
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "CA",
"license": "G29068",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G290680",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.