NPIMap

Organization Active NPI

Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Loma Linda, CA
National Provider Identifier
1992463251
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Practice address
11374 Mt View Ave Ste a
Loma Linda, CA 92354-3816
Phone
(909) 558-6715
NPI assigned
Dec 3, 2021
Last updated
Dec 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Authorized official

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Pediatric Nurse Practitioner 363LP0200X NU
Forensic Psychologist 103TF0200X NU
Pediatrics Physician 208000000X NU Primary
Pediatric Medical Toxicology Physician 2080T0002X NU
Forensic Psychiatry Physician 2084F0202X NU
Child Abuse Pediatrics Physician 2080C0008X NU

Addresses

Primary practice location

11374 Mt View Ave Ste a
Loma Linda, CA 92354-3816

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

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

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638489600000",
    "number": "1992463251",
    "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",
            "fax_number": "909-651-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11374 MT VIEW AVE STE A",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543816",
            "telephone_number": "909-558-6715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACULTY PHYSICIANS AND SURGEONS OF LLUSM",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-11-23",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080T0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Medical Toxicology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.