NPIMap

Faculty Physicians and Surgeons of Llusm

Organization Active NPI Family Medicine Physician · Redlands, CA

NPI 1891472494 · NPPES record last updated Jul 5, 2023

Key facts

NPI
1891472494
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Practice address
1782 W Park Ave
Redlands, CA 92373-3115
Phone
(909) 651-1700
Fax
(909) 651-1751
NPI assigned
Jul 5, 2023
Organization subpart
No

Authorized official

Name
Ricardo Peverini, MD
Title
President
Phone
(909) 651-5582

Corporate family (same tax ID) 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031211000981 CA Part B Supplier - Clinic/Group Practice 1153227814 Receives reassigned benefits from 2,632 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Loma Linda University P (32 organizations share this tax ID)

Locations

1782 W Park Ave
Redlands, CA 92373
Phone (909) 651-1700

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

1782 W Park Ave
Redlands, CA 92373-3115

Mailing address

File Number 54701
Los Angeles, CA 90074-4701
Phone (909) 651-4352

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 5, 2023.

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1891472494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NUMBER 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-651-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1782 W PARK AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733115",
            "telephone_number": "909-651-1700",
            "fax_number": "909-651-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "PEVERINI",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-651-5582",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

All providers in Redlands, CA · Family Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.