Roland Jayson Formoso Pua, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

12103 Issued in NV

Practice address

9460 W Flamingo Rd
Suite 120
Las Vegas, NV 89147-5742

Phone

(702) 638-7705

Fax

(702) 638-7706

NPI assigned

Nov 13, 2006

Last updated

Jan 29, 2024By 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 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NV, UT, OR, CA4 enrollments

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 4

Specialty

Internal MedicineAlso: Geriatric Medicine

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Group LLCGroup PAC ID 3072669183, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fidelity Home Health Services, LLC Home health agency, Las Vegas, NV, CCN 297217
• Beloved Hospice, Inc Hospice, Wilsonville, OR, CCN 381584

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rolandpua@tmgllc.allscriptsdirect.net

All facility ownership & control disclosures 3

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

Owned or controlled facilities with NPI records 3

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

• Royal Majesty Home Health, Inc.

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1215109012

  Contracted Managing Employee

  CMS ownership
• South Las Vegas Medical Investors, LLC

  dba Life Care Center of South Las Vegas

  • Skilled Nursing Facility
  • Las Vegas, NV
  • NPI 1700837416

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Beloved Hospice, Inc.

  • Community Based Hospice Care Agency
  • Wilsonville, OR
  • NPI 1932808078

  5% Or Greater Direct Ownership Interest

  CMS ownership

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.

• Medical Group LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1366681538
  Medicare reassignment Care Compare group NPD
• Nevada Acute Medical Services-Scherr 1 PC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1992244438
  Medicare reassignment NPD
• Platinum Hospitalists LLP

  • Hospitalist Physician
  • Henderson, NV
  • NPI 1861627242
  Medicare reassignment NPD
• Claris Health PLLC

  • General Practice Physician
  • Irving, TX
  • NPI 1356797070

  UT

  Medicare reassignment
• QRD Health LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1124590203
  Authorized official Same address or phone
• Platinum Hospitalists LLP

  dba Platinum Continuity and Specialty Clinic

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1437948726
  NPD
• Beloved Hospice, Inc.

  • Community Based Hospice Care Agency
  • Wilsonville, OR
  • NPI 1932808078
  NPD
• Beloved Medical, LLC

  • Internal Medicine Physician
  • Wilsonville, OR
  • NPI 1548960495

  Geriatric Medicine

  NPD
• Iyad Houshan, M.D. Professional Corporation

  dba Gerinet Of Nevada

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1467514729

  Geriatric Medicine

  NPD (past)
• Shivay Saran International Chartered

  • Internal Medicine Physician
  • N Las Vegas, NV
  • NPI 1811041841
  NPD (past)
• South Las Vegas Medical Investors, LLC

  dba Life Care Center of South Las Vegas

  • Skilled Nursing Facility
  • Las Vegas, NV
  • NPI 1700837416
  NPD (past)
• Rabessler MD PC

  • Internal Medicine Physician
  • Jesup, GA
  • NPI 1174731970
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fidelity Home Health Services LLC

  • Home Health Agency
  • Las Vegas, NV
  • NPI 1225415185
  Care Compare affiliation
• Beloved Hospice, Inc.

  • Community Based Hospice Care Agency
  • Wilsonville, OR
  • NPI 1932808078
  Care Compare affiliation

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1215009782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11794 LONGWORTH RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891351323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9460 W FLAMINGO RD",
            "address_2": "SUITE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891475742",
            "telephone_number": "702-638-7705",
            "fax_number": "702-638-7706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1144 65th St Ste F",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946081053",
            "country_code": "US",
            "telephone_number": "510-929-1400",
            "fax_number": "510-929-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "781 Mill St",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021320",
            "country_code": "US",
            "telephone_number": "775-398-1980",
            "fax_number": "775-398-1981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUA",
        "first_name": "ROLAND JAYSON",
        "middle_name": "FORMOSO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "AZ",
            "license": "67340",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD202126",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "C175306",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "ID",
            "license": "15963",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NV",
            "license": "12103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• PTW Holdings LLC (Skye Canyon Home Care)
• PTW Holdings LLC (Skye Canyon Home Care)
• Vonn Pu
• Robert Uy Pua, RCP
• Nicole Pucci, M.S.W
• Julianne Puchalsky-Szabo, MFT INTERN
• Joshua Puckett
• Nicolaus Puckett
• Andrew Pudjowargono, OD

• Geriatric Medicine (Internal Medicine) Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Geriatric Medicine (Internal Medicine) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.