NPIMap

Individual provider Active NPI

Adrian P Lavery, M.D, MPH

  • Neonatal-Perinatal Medicine Physician
  • Loma Linda, CA
National Provider Identifier
1023152196
Registry record updated Mar 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
A116763 Issued in CA
Practice address
11175 Campus Street
Coleman Pavilion Suite 11121 Department of Neonatology
Loma Linda, CA 92354
Phone
(909) 651-5746
Fax
(909) 558-0298
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.089269 OH
Neonatal-Perinatal Medicine Physician 2080N0001X 060400 GA
Neonatal-Perinatal Medicine Physician 2080N0001X A116763 CA Primary

Addresses

Primary practice location

11175 Campus Street
Coleman Pavilion Suite 11121 Department of Neonatology
Loma Linda, CA 92354

Mailing address

11175 Campus Street
Coleman Pavilion Suite 11121 Department of Neonatology
Loma Linda, CA 92354
Phone (909) 651-5746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111024000246 CA Practitioner - Pediatric Medicine 6901881374 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.089269OHMDPediatrics Physician
060400GAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Sep 14, 2011 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Pediatrics CurrentSince Sep 14, 2011 Accepting new patients
Children'S Hospital Medical Center Past Accepting new patients
Pediatric Subspecialty Faculty, Inc. Pediatrics Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Diagnostic Imaging Services Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Northside Hospital, Inc. Past Accepting new patients

Locations

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

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

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458777600000",
    "number": "1023152196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS STREET",
            "address_2": "COLEMAN PAVILION SUITE 11121 DEPARTMENT OF NEONATOLOGY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-651-5746",
            "fax_number": "909-558-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS STREET",
            "address_2": "COLEMAN PAVILION SUITE 11121 DEPARTMENT OF NEONATOLOGY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-651-5746",
            "fax_number": "909-558-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVERY",
        "first_name": "ADRIAN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2016-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.089269",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "GA",
            "license": "060400",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A116763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.