Active NPI
Faculty Physicians and Surgeons of Llusm
- Ophthalmology Physician
- Riverside, CA
National Provider Identifier
1457301285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- FACULTY PHYSICIANS AND SURGEONS OF LLUSM
- Practice address
- 4515 Central Ave
Suite 101
Riverside, CA 92506-2374 - Phone
- (951) 784-4713
- Fax
- (909) 558-3905
- NPI assigned
- May 11, 2006
- Last updated
- Sep 22, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ricardo Peverini, M.D.
- Title
- President
- Phone
- (909) 558-7448
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
4515 Central Ave
Suite 101
Riverside, CA 92506-2374
Mailing address
File Number 54701
Los Angeles, CA 90074-0001
Phone (909) 558-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0091662 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031211000981 | CA | Part B Supplier - Clinic/Group Practice | 1153227814 |
Receives reassigned benefits from 2,632 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758499200000",
"number": "1457301285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FILE NUMBER 54701",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900740001",
"telephone_number": "909-558-3111",
"fax_number": "909-558-3905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 CENTRAL AVE",
"address_2": "SUITE 101",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925062374",
"telephone_number": "951-784-4713",
"fax_number": "909-558-3905"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-11",
"last_updated": "2025-09-22",
"certification_date": "2025-09-22",
"status": "A",
"authorized_official_last_name": "PEVERINI",
"authorized_official_first_name": "RICARDO",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "909-558-7448",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0091662",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
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- Faculty Physicians and Surgeons of Llusm
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; 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.