NPIMap

Organization Active NPI

Faculty Physicians and Surgeons of Llusm

  • Surgery Physician
  • Riverside, CA
National Provider Identifier
1013967405
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Practice address
3762 Tibbetts St
Riverside, CA 92506-2605
Phone
(951) 686-2224
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Ricardo Peverini, M.D.
Title
President
Phone
(909) 558-7448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

3762 Tibbetts St
Riverside, CA 92506-2605

Mailing address

File Number 54701
Los Angeles, CA 90074-0001
Phone (909) 558-3111

Other identifiers 1

IdentifierTypeStateIssuer
GR006972BMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000981 CA Part B Supplier - Clinic/Group Practice 1153227814 Receives reassigned benefits from 2,632 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 102

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 102

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1013967405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NUMBER 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "909-558-3111",
            "fax_number": "909-558-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3762 TIBBETTS ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062605",
            "telephone_number": "951-686-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "PEVERINI",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-558-7448",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR006972B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.