Individual provider Active NPI

Elizabeth Suwartono Pagler, M.D.

  • Family Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1295185254
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A163137 Issued in CA
Practice address
11398 Kenyon Way Ste J
Rancho Cucamonga, CA 91701-9229
Phone
(909) 727-3911
Fax
(909) 727-3925
NPI assigned
Jun 20, 2016
Last updated
Nov 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A163137 CA Primary

Addresses

Primary practice location

11398 Kenyon Way Ste J
Rancho Cucamonga, CA 91701-9229

Mailing address

11398 Kenyon Way Ste J
Rancho Cucamonga, CA 91701-9229
Phone (909) 727-3911

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230306001482 CA Practitioner - Family Practice 1658669221 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lani City MedicalGroup PAC ID 9436406550, 3 clinicians

Practice addresses (Care Compare)

11398 Kenyon Way
Suite J
Rancho Cucamonga, CA 91701-9229
Phone (909) 727-3911

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A163137CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vvipa Medical Group Inc Family Medicine CurrentSince Aug 15, 2022 Accepting new patients
Lani City Medical CurrentSince Aug 1, 2025 Accepting new patients
Lani City Medical Specialty CurrentSince Aug 1, 2025 Accepting new patients
High Desert Medical Group Family Medicine Current Accepting new patients
Lani City Medical Riverside Family Medicine Past Accepting new patients
Kenneth V. Miselis, M.D. Inc. PastSince Aug 16, 2020 Accepting new patients

Locations

4036 Grand Ave
Chino, CA 91710

4036 Grand Ave
Ste A
Chino, CA 91710
Phone 9097273911 ext. 2

11398 Kenyon Way
Ste J
Rch Cucamonga, CA 91701
Phone (909) 527-0266

150 W Base Line Rd
Rialto, CA 92376

2915 Van Buren Blvd
Ste J2
Riverside, CA 92503

12370 Hesperia Rd
Ste 2
Victorville, CA 92395
Phone (760) 245-4747

12408 Hesperia Rd
Ste 2
Victorville, CA 92395
Phone (760) 553-7000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: elizabeth.pagler.1@18340.direct.athenahealth.com
  • Direct secure messaging: elizabeth.pagler.p2@direct.hvvmg.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1295185254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11398 KENYON WAY STE J",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917019229",
            "telephone_number": "909-727-3911",
            "fax_number": "909-727-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11398 KENYON WAY STE J",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917019229",
            "telephone_number": "909-727-3911",
            "fax_number": "909-727-3925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGLER",
        "first_name": "ELIZABETH",
        "middle_name": "SUWARTONO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A163137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.