William Jacob Pevsner, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

W20A5383 Issued in CA

Practice address

1334 W Covina Blvd Ste 103
San Dimas, CA 91773-3211

Phone

(909) 394-9090

Fax

(909) 394-9696

NPI assigned

Jan 2, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

College of Osteo Med of the Pacific at Pomona, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: william.pevsner.p9@direct.healthcarepartners.nextgenshare.com

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.

• Splinter Medical Group, Inc.

  • Family Medicine Physician
  • San Dimas, CA
  • NPI 1629053723
  Medicare reassignment NPD Authorized official
• San Dimas Community Hospital, Inc.

  • Skilled Nursing Facility
  • San Dimas, CA
  • NPI 1568487619
  NPD (past)

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199232000000",
    "number": "1679758171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1334 W COVINA BLVD STE 103",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733211",
            "telephone_number": "909-394-9090",
            "fax_number": "909-394-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 W COVINA BLVD STE 103",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733211",
            "telephone_number": "909-394-9090",
            "fax_number": "909-394-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEVSNER",
        "first_name": "WILLIAM",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-02",
        "last_updated": "2008-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "W20A5383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystsl Ann Perez
• Lisa Perez
• Mirella Perez
• Vanessa Perez
• Jodi Elson Peterson, MA, LMFT
• Vincent The Phan
• Rosalyn Alejo Phillips, LMFT
• Sara Michele Phillips, APCC 15753
• Brett P Pierce
• Stephanie Pimentel

• Family Medicine Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.