NPIMap

Organization Active NPI

Faculty Medical Group of Llusm

  • Emergency Medicine Physician
  • Murrieta, CA
National Provider Identifier
1659677433
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
FACULTY MEDICAL GROUP OF LLUSM
Practice address
28062 Baxter Road
Murrieta, CA 92563
Phone
(909) 558-3111
NPI assigned
Jan 27, 2011
Organization subpart
Yes
Parent organization
FACULTY MEDICAL GROUP OF LLUSM INDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Authorized official

Name
Ms. Lisa Wolter
Title
Provider Enrollment Rep
Phone
(909) 558-3289

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary
Sports Medicine (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PS0010X

Addresses

Primary practice location

28062 Baxter Road
Murrieta, CA 92563

Mailing address

11165 Mountain View Ave
Ste 228
Loma Linda, CA 92354-3866
Phone (909) 558-3111

Other names 1

  • FMG-ED MURRIETA Other name

National Provider Directory

National Provider Directory
Part of
Faculty Medical Group of Llusm

Practitioners & affiliated clinicians

Practitioners 5

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": "1296086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1659677433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11165 MOUNTAIN VIEW AVE",
            "address_2": "STE 228",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543866",
            "telephone_number": "909-558-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28062 BAXTER ROAD",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "92563",
            "telephone_number": "909-558-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACULTY MEDICAL GROUP OF LLUSM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FACULTY MEDICAL GROUP OF LLUSM IND",
        "enumeration_date": "2011-01-27",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "WOLTER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT REP",
        "authorized_official_telephone_number": "909-558-3289",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMG-ED MURRIETA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.