Riverside Eye Specialists Medical Group Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

RIVERSIDE EYE SPECIALISTS MEDICAL GROUP INC.

Practice address

4605 Brockton Ave
Suite 100
Riverside, CA 92506-0106

Phone

(951) 686-4911

Fax

(951) 686-9409

NPI assigned

Apr 3, 2006

Last updated

Nov 26, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ray Rogers Glendrange, M.D.NPI 1164484507

Title

Secretary/Owner

Phone

(951) 686-4911

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Riverside Eye Partners a Professional Medical Corporation

  • Medical Specialty Clinic/Center
  • Riverside, CA
  • NPI 1710460878

  Member Of

  NPD member

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 6

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.

• Ray Rogers Glendrange, M.D.

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1164484507
  Medicare reassignment Care Compare group NPD Authorized official
• Khalid Mahmoud Aldaas, MD

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1992325989
  Medicare reassignment Care Compare group NPD
• Derrick Lai

  • Optometrist
  • Riverside, CA
  • NPI 1235825886
  Medicare reassignment Care Compare group NPD
• John J Allavie, M.D.

  • Ophthalmology Physician
  • Riverside, CA
  • NPI 1740242627
  Medicare reassignment NPD
• Jennifer Hua, OD

  • Optometrist
  • Riverside, CA
  • NPI 1215384532
  Medicare reassignment NPD
• Jonathan P Perlman, MD

  • Ophthalmology Physician
  • Woodland, CA
  • NPI 1972510477
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1508828963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 BROCKTON AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925060106",
            "telephone_number": "951-686-4911",
            "fax_number": "951-686-9409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 BROCKTON AVE",
            "address_2": "SUITE 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925060106",
            "telephone_number": "951-686-4911",
            "fax_number": "951-686-9409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE EYE SPECIALISTS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "GLENDRANGE",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "ROGERS",
        "authorized_official_title_or_position": "SECRETARY/OWNER",
        "authorized_official_telephone_number": "951-686-4911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO, GBA",
            "identifier": "CD8734",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079980",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riverside Elite Advantage Care Home LLC
• Riverside Elite Imaging , Inc
• Riverside Emergency Physicians Medical Group
• Riverside Equities LLC (Mission Care Center)
• Riverside Eye Partners a Professional Medical Corporation
• Riverside Eye, Ear, Nose,Throat Institute
• Riverside Family Acupuncture
• Riverside Family Physicians (Riverside Family Physicians - Orange)
• Riverside Family Physicians (Riverside Family Physicians - Parkview)
• Riverside Family Physicians, a Professional Medical Corporation

• Ophthalmology Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.