Individual ProviderIan ReillyEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address9888 Genesee Ave, La Jolla, CA 92037-1205(858) 354-6049PECOS EnrollmentBased on the most recent information from CMS, provider Ian Reilly is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1073581914Provider TypeIndividualFull NameReilly, IanCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date3/8/2006Last Updated12/3/2013Contact InformationPractice LocationPractice Address9888 Genesee Ave, La Jolla, CA 92037-1205Phone(858) 354-6049FaxUnlisted FaxMailing LocationMailing Address9888 Genesee Ave, La Jolla, CA 92037-1205Phone(858) 354-6049FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicenseA76423CaliforniaProvider IdentifiersIDDescriptionIssuerID00A764230DescriptionMedicaidIssuerUnlistedCalifornia