NPIMap

Individual provider Active NPI

Lou Brunnel Roldan Tayong, APRN

  • Family Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1700447687
Registry record updated Dec 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
811874 Issued in NV
Practice address
1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone
(702) 383-2000
NPI assigned
Jun 22, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 811874 NV Primary

Addresses

Primary practice location

1800 W. Charleston Blvd.
Las Vegas, NV 89102

Mailing address

1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone (702) 383-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191202000375 NV Practitioner - Nurse Practitioner 2365875549 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
811874NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Group Rhodes P C CurrentSince Oct 21, 2019 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Dec 16, 2021 Accepting new patients
Optum Medical Group Rhodes P C CurrentSince Oct 21, 2019 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Dec 16, 2021 Accepting new patients

Locations

58 N Pecos Rd
Henderson, NV 89074
Phone (702) 822-2000

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

6240 N Durango Dr
Ste 120
Las Vegas, NV 89149
Phone (702) 202-3431

Organizations & group practices 4

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1561161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1700447687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W. CHARLESTON BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89102",
            "telephone_number": "702-383-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W. CHARLESTON BLVD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89102",
            "telephone_number": "702-383-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYONG",
        "first_name": "LOU BRUNNEL",
        "middle_name": "ROLDAN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-22",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "811874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.