Organization Active NPI

Regal Medical Group LLC

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1457034795
Registry record updated Aug 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REGAL MEDICAL GROUP LLC
Practice address
1500 E Tropicana Ave Ste 164
Las Vegas, NV 89119-8314
Phone
(424) 205-9207
NPI assigned
Aug 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2023

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

Authorized official

Name
Mrs. Armi Regala San Agustin
Title
Managing Member
Phone
(424) 205-9207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1500 E Tropicana Ave Ste 164
Las Vegas, NV 89119-8314

Mailing address

1500 E Tropicana Ave Ste 164
Las Vegas, NV 89119-8314
Phone (424) 205-9207

Other practice location 1

1500 E Tropicana Ave Ste 164
Las Vegas, NV 89119-8314
Phone (424) 205-9207

Other names 1

  • N/A Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231017003605 NV Part B Supplier - Clinic/Group Practice 1759736341 Receives reassigned benefits from 4 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

1500 E Tropicana Ave
Ste 164
Las Vegas, NV 89119
Phone (702) 659-9617

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691712000000",
    "number": "1457034795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E TROPICANA AVE STE 164",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891198314",
            "telephone_number": "424-205-9207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E TROPICANA AVE STE 164",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891198314",
            "telephone_number": "424-205-9207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Tropicana Ave Ste 164",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891198314",
            "country_code": "US",
            "telephone_number": "424-205-9207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REGAL MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A",
        "authorized_official_last_name": "SAN AGUSTIN",
        "authorized_official_first_name": "ARMI",
        "authorized_official_middle_name": "REGALA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "424-205-9207",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.