NPIMap

Individual provider Active NPI

Peter Lac, M.D.

  • Nephrology Physician
  • Wildomar, CA
National Provider Identifier
1881617652
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A91135 Issued in CA
Practice address
36320 Inland Valley Dr Ste 308
Wildomar, CA 92595-7512
Phone
(951) 600-7630
Fax
(951) 600-7164
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A91135 CA Primary

Addresses

Primary practice location

36320 Inland Valley Dr Ste 308
Wildomar, CA 92595-7512

Mailing address

3660 Park Sierra Dr Ste 203
Riverside, CA 92505-3071
Phone (951) 687-3400

Other practice location 1

591 E Elder St Ste C
Fallbrook, CA 92028-5001
Phone (951) 687-7140

Other practice location 2

27851 Bradley Rd
Menifee, CA 92586-2286
Phone (951) 672-7967

Other identifiers 1

IdentifierTypeStateIssuer
A91135OtherCALIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20060901000360 CA Practitioner - Internal MedicinePractitioner - Nephrology 5597769604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
University of California, Irvine, California College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates Medical Group IncGroup PAC ID 5092604447, 64 clinicians

Practice addresses (Care Compare)

27851 Bradley Rd
Suite 125
Menifee, CA 92586-2282
Phone (951) 672-7967

Hospital & facility affiliations

  • DaVita Sun City Menifee Dialysis Dialysis facility, Perris, CA, CCN 552715
  • DaVita Menifee Home Dialysis Dialysis facility, Menifee, CA, CCN 552780
  • DaVita Hemet Dialysis Center Dialysis facility, Hemet, CA, CCN 052620
  • DaVita Diamond Valley Dialysis Center Dialysis facility, San Jacinto, CA, CCN 052768
  • Loma Linda University Medical Center-Murrieta Hospital, Murrieta, CA, CCN 050770
  • Hemet Global Medical Center Hospital, Hemet, CA, CCN 050390
  • Menifee Global Medical Center Hospital, Sun City, CA, CCN 050684
  • Southwest Healthcare Rancho Springs Hospital Hospital, Murrieta, CA, CCN 050701
  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A91135CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Health Services of Rancho Springs Inc Past Accepting new patients
Hemet Valley Medical Center Past Accepting new patients
Inpatient Management Medical Group Inc Past Accepting new patients
Temecula Valley Hospital Inc Past Accepting new patients
Dignity Health Past Accepting new patients
Bio-Medical Applications of California, Inc. PastSince Apr 15, 2020 Accepting new patients
Nephrology Associates Medical Group, Inc. PastSince Aug 15, 2021 Accepting new patients
Physicians' Hospital of Murrieta, LLC Past Accepting new patients
Menifee Valley Medical Center Past Accepting new patients
Primecare Medical Group Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: plac181999@direct.llu.edu
  • Direct secure messaging: peter.lac.1@19859.direct.athenahealth.com

Organizations & group practices 11

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 9

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1881617652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 PARK SIERRA DR STE 203",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053071",
            "telephone_number": "951-687-3400",
            "fax_number": "951-687-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36320 INLAND VALLEY DR STE 308",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957512",
            "telephone_number": "951-600-7630",
            "fax_number": "951-600-7164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "591 E Elder St Ste C",
            "address_purpose": "LOCATION",
            "city": "Fallbrook",
            "state": "CA",
            "postal_code": "920285001",
            "country_code": "US",
            "telephone_number": "951-687-7140",
            "fax_number": "951-303-3565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27851 Bradley Rd",
            "address_purpose": "LOCATION",
            "city": "Menifee",
            "state": "CA",
            "postal_code": "925862286",
            "country_code": "US",
            "telephone_number": "951-672-7967",
            "fax_number": "951-246-3747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAC",
        "first_name": "PETER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A91135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC",
            "identifier": "A91135",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

Verify at the official NPI Registry.