Individual provider Active NPI

Pharez Dishon Rolle

  • Psychiatry Physician
  • Loma Linda, CA
National Provider Identifier
1477964427
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A143415 Issued in CA
Practice address
11234 Anderson St
Loma Linda University Medical Center Psychiatry
Loma Linda, CA 92354
Phone
(909) 558-9532
NPI assigned
May 13, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A143415 CA Primary

Addresses

Primary practice location

11234 Anderson St
Loma Linda University Medical Center Psychiatry
Loma Linda, CA 92354

Mailing address

11234 Anderson St
Westerly BLDG-Suite C
Loma Linda, CA 92354-2804
Phone (909) 558-4174

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
I20180611002725 CA Practitioner - Psychiatry 7911252192 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Loma Linda University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

1686 Barton Rd
Redlands, CA 92373-1488
Phone (909) 558-9551

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jul 1, 2018 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Psychiatry CurrentSince Jul 1, 2018 Accepting new patients
Sac Health System Current Accepting new patients
Sac Health System CurrentSince Sep 15, 2018 Accepting new patients
Sac Health System CurrentSince Sep 15, 2018 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

11234 Anderson St
#C
Loma Linda, CA 92350
Phone (909) 558-4074

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

1686 Barton Rd
#2100
Redlands, CA 92373

1686 Barton Rd
Redlands, CA 92373
Phone (909) 558-9200

250 S G St
San Bernardino, CA 92410
Phone (909) 771-2990

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: prolle24384@direct.llu.edu

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1477964427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "WESTERLY BLDG-SUITE C",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "LOMA LINDA UNIVERSITY MEDICAL CENTER PSYCHIATRY",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-558-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLLE",
        "first_name": "PHAREZ",
        "middle_name": "DISHON",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-13",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A143415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.