NPIMap

Individual provider Active NPI

Edilberto Lumelay Agas Jr., M.D.

  • Pediatrics Physician
  • Riverside, CA
National Provider Identifier
1346431145
Registry record updated Jan 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A100860 Issued in CA
Practice address
6926 Brockton Ave
Suite 6
Riverside, CA 92506-3800
Phone
(951) 779-1670
Fax
(951) 779-1670
NPI assigned
Aug 6, 2007
Last updated
Jan 10, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A100860 CA Primary

Addresses

Primary practice location

6926 Brockton Ave
Suite 6
Riverside, CA 92506-3800

Mailing address

6926 Brockton Ave
Suite 6
Riverside, CA 92506-3800
Phone (951) 779-1670

Other identifiers 1

IdentifierTypeStateIssuer
A100860OtherCASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A100860CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Healthcare System, L.P. Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Uhs Corona Inc Past Accepting new patients
Mission Pediatrics, Inc. Pediatrics Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357776000000",
    "number": "1346431145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6926 BROCKTON AVE",
            "address_2": "SUITE 6",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063800",
            "telephone_number": "951-779-1670",
            "fax_number": "951-779-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6926 BROCKTON AVE",
            "address_2": "SUITE 6",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063800",
            "telephone_number": "951-779-1670",
            "fax_number": "951-779-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAS",
        "first_name": "EDILBERTO",
        "middle_name": "LUMELAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-06",
        "last_updated": "2013-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A100860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A100860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.