Roland Spurgeon Beverly III, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G65658 Issued in CA

Practice address

24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065

Phone

(949) 831-3057

Fax

(949) 831-2515

NPI assigned

Feb 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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 and National Provider Directory roles.

• J Robert West, M.D., Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1932154788
  Medicare reassignment NPD
• J. Robert West, M.D., Inc

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1114567997
  NPD (past)

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

{
    "created_epoch": "1139616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1083687776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR",
            "address_2": "SUITE 103",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563065",
            "telephone_number": "949-831-3057",
            "fax_number": "949-831-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR",
            "address_2": "SUITE 103",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563065",
            "telephone_number": "949-831-3057",
            "fax_number": "949-831-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVERLY",
        "first_name": "ROLAND",
        "middle_name": "SPURGEON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-11",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G65658",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "G65658",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Berkdar Dental PC
• Ahd Berkdar
• Princess Berry
• Natalie Anne Berthe
• Beverly Dermatology and Laser Center
• Ambika Bhushan
• Melanie Rachelle Bigda, CPM, LM
• Shahnam Zand Biglari, PHARMD, BCNP
• Reza Mohammad Birjandi, DDS
• Paul Bishop

• Dermatology Physician in Aliso Viejo, CA
• Providers in Aliso Viejo, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.