Jack Alan Laurie, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G43352 Issued in CA

Practice address

6405 Day St
Riverside, CA 92507-0901

Phone

(951) 697-5430

Fax

(951) 697-5488

NPI assigned

Nov 30, 2005

Last updated

Nov 15, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Dermatology Physician
  • Riverside, CA
  • NPI 1720183403
  Medicare reassignment NPD
• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1730180415

  Pediatrics

  NPD
• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Family Medicine Physician
  • Eastvale, CA
  • NPI 1972845535

  Pediatrics

  NPD

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1063496545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 ARLINGTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063912",
            "telephone_number": "951-782-5110",
            "fax_number": "951-274-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 DAY ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925070901",
            "telephone_number": "951-697-5430",
            "fax_number": "951-697-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAURIE",
        "first_name": "JACK",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G43352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP SITE LOCATION",
            "identifier": "ZZZ92058Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Wai-Ga Lau, MD
• Sharon Marie Laughlin, M.D.
• Lauren Tabila Laughman, MD
• Laura Nguyen OD, Inc (Clear Vision Optometry)
• Lauren Nghia Tang, O.D. Inc
• Nancy E Laurman, CNM
• Victor Guansing Laus, M.D.
• Taylor Laut, M.S., L.C.G.C.
• Michael F. Lavallee, MD
• Kyllie Lavalleur

• Pediatrics Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.