NPIMap

Organization Active NPI

Faculty Physicians and Surgeons of Llusm

  • Transplant Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1124560214
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Transplant Surgery PhysicianTaxonomy code 204F00000X
Legal business name
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Practice address
2020 Wellness Way
Ste 506
Las Vegas, NV 89106-4145
Phone
(909) 558-3636
Fax
(909) 651-4586
NPI assigned
Nov 7, 2016
Last updated
Jul 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Authorized official

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Surgical Physician Assistant 363AS0400X NU
Nurse Practitioner 363L00000X NU
Transplant Surgery Physician 204F00000X NU Primary
Hepatology Physician 207RI0008X NU
Transplant Hepatology Physician 207RT0003X NU

Addresses

Primary practice location

2020 Wellness Way
Ste 506
Las Vegas, NV 89106-4145

Mailing address

File # 54701
Los Angeles, CA 90074-4701
Phone (909) 558-4000

Other practice location 1

2020 Goldring Ave
Suite 506
Las Vegas, NV 89106-4000
Phone (909) 558-3636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments

Enrollment records 2

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
O20170324001381 NV Part B Supplier - Clinic/Group Practice 1153227814 Receives reassigned benefits from 8 practitioners
Practice locations: Las Vegas, NV

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Totally Kids Rehabilitation HospitalLoma Linda, CA, CCN 555587 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Aug 29, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1124560214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-558-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 WELLNESS WAY",
            "address_2": "STE 506",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064145",
            "telephone_number": "909-558-3636",
            "fax_number": "909-651-4586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 Goldring Ave",
            "address_2": "Suite 506",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891064000",
            "country_code": "US",
            "telephone_number": "909-558-3636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2019-07-19",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0008X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hepatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RT0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Transplant Hepatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.