Active NPI
Ray Lengvilas, M.D.
- Pediatrics Physician
- San Bernardino, CA
National Provider Identifier
1265744718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- R71994
- Practice address
- 742 W Highland Ave
San Bernardino, CA 92405-3839 - Phone
- (909) 881-7320
- NPI assigned
- Jul 12, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R71994 | AZ | Primary |
| Pediatrics Physician | 208000000X | A123121 | CA |
Addresses
Primary practice location
742 W Highland Ave
San Bernardino, CA 92405-3839
Mailing address
742 W Highland Ave
San Bernardino, CA 92405-3839
Phone (909) 881-7320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R71994 | Other | AZ | TRAINING PERMIT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190910002395 | NY | Order and Referring Only - Pediatric Medicine | 8426387895 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R71994 | AZ | MD | Pediatrics Physician |
| A123121 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377129600000",
"number": "1265744718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "742 W HIGHLAND AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924053839",
"telephone_number": "909-881-7320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "742 W HIGHLAND AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924053839",
"telephone_number": "909-881-7320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LENGVILAS",
"first_name": "RAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-12",
"last_updated": "2013-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "R71994",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A123121",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAINING PERMIT",
"identifier": "R71994",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.