Individual provider Active NPI

Wesley P Phipatanakul, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Loma Linda, CA
National Provider Identifier
1932135654
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
A81135 Issued in CA
Practice address
25455 Barton Rd
Suite 102B
Loma Linda, CA 92354-3128
Phone
(909) 558-2808
NPI assigned
Jun 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A81135 CA
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X A81135 CA Primary

Addresses

Primary practice location

25455 Barton Rd
Suite 102B
Loma Linda, CA 92354-3128

Mailing address

11406 Loma Linda Dr
Suite 218
Loma Linda, CA 92354-3711
Phone (909) 558-6444

Other identifiers 1

IdentifierTypeStateIssuer
00A811350MedicaidCA

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
I20040830000733 CA Practitioner - Sports MedicinePractitioner - Orthopedic Surgery 9032184460 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Orthopedic Surgery
Education
Loma Linda University School of Medicine, 1998
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

11370 Anderson St
Loma Linda, CA 92354-3450

25455 Barton Rd
Loma Linda, CA 92354-3128
Phone (909) 558-2808

Hospital & facility affiliations

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)36
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A81135CAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Sep 1, 2004 Accepting new patients
Sac Health System CurrentSince Aug 2, 2016 Accepting new patients
Sac Health System CurrentSince Aug 2, 2016 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Sep 1, 2004 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Orthopaedic Surgery Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients

Locations

900 E Washington St
Ste 200
Colton, CA 92324
Phone (909) 882-5867

900 S Main St
Ste 105
Corona, CA 92882
Phone (909) 734-6500

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

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

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

25455 Barton Rd
Ste 102B
Loma Linda, CA 92354
Phone (909) 558-2808

11370 Anderson St
Ste 1500
Loma Linda, CA 92354
Phone (909) 558-2802

25455 Barton Rd
Loma Linda, CA 92354
Phone (909) 558-2808

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

28078 Baxter Rd
Murrieta, CA 92563
Phone (951) 290-4000

1686 Barton Rd
Redlands, CA 92373
Phone (909) 558-9200

250 S G St
San Bernardino, CA 92410
Phone (909) 771-2990

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: wphipatanakul10222@direct.llu.edu

Organizations & group practices 8

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1932135654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR",
            "address_2": "SUITE 218",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD",
            "address_2": "SUITE 102B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543128",
            "telephone_number": "909-558-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHIPATANAKUL",
        "first_name": "WESLEY",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A81135",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A81135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A811350",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.