Dr Jonathan Melton Lish, MD is a medicare enrolled "Family Medicine" physician in San Bruno, California. His current practice location is
851 Cherry Ave Ste 4, San Bruno, California. You can reach out to his office (for appointments etc.) via phone at
(650) 273-9412.
Dr Jonathan Melton Lish is licensed to practice in California (license number A177373) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1811459456.
Physician's Profile
| Full Name | Dr Jonathan Melton Lish |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 851 Cherry Ave Ste 4, San Bruno, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1811459456
- Provider Enumeration Date: 04/03/2019
- Last Update Date: 11/21/2024
Medicare PECOS Information:
- PECOS PAC ID: 7911376991
- Enrollment ID: I20221214000705
Medical Identifiers
Medical identifiers for Dr Jonathan Melton Lish such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1811459456 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | A177373 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jonathan Melton Lish allows following entities to bill medicare on his behalf.
| Entity Name | Sharp Rees-stealy Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1285616177
PECOS PAC ID: 8628972759
Enrollment ID: O20031120000996 |
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| Entity Name | Sutter Bay Medical Foundation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1013950807
PECOS PAC ID: 4284538778
Enrollment ID: O20031125000909 |
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| Entity Name | Family Health Centers Of San Diego Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447281936
PECOS PAC ID: 3476446378
Enrollment ID: O20040204000923 |
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| Entity Name | Vitruvianmd Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053031716
PECOS PAC ID: 4385013366
Enrollment ID: O20221214000644 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jonathan Melton Lish is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Jonathan Melton Lish, MD
Po Box 276950,
Sacramento, CA 95827-6950
Ph: (650) 273-9412 | Dr Jonathan Melton Lish, MD
851 Cherry Ave Ste 4,
San Bruno, CA 94066-2953
Ph: (650) 273-9412 |
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