Individual provider Active NPI

Jesus Lua, M.D.

  • Family Medicine Physician
  • Upland, CA
National Provider Identifier
1992776108
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A50698 Issued in CA
Practice address
360 E 7TH St
Suite a
Upland, CA 91786-6701
Phone
(909) 985-5784
Fax
(909) 985-7844
NPI assigned
Jan 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A50698 CA Primary

Addresses

Primary practice location

360 E 7TH St
Suite a
Upland, CA 91786-6701

Mailing address

360 E 7TH St
Suite a
Upland, CA 91786-6701
Phone (909) 985-5784

Other identifiers 2

IdentifierTypeStateIssuer
00A506980MedicaidCA
1497955132MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071207000703 CA Practitioner - Family Practice 2961591326 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

360 E 7TH St
Suite a
Upland, CA 91786-6701
Phone (909) 985-5784

Hospital & facility affiliations

  • Vanura Home Health Services, Inc Home health agency, Rancho Cucamonga, CA, CCN 058181
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A50698CAMDFamily Medicine Physician

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
Remedial Medical Services Inc General Practice CurrentSince May 1, 2021 Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients

Locations

3576 Arlington Ave
Ste 205
Riverside, CA 92506
Phone (951) 530-8972

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HIFFBA/Endpoint/HIFFBA

Organizations & group practices 5

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 2

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": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1992776108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST",
            "address_2": "SUITE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-985-5784",
            "fax_number": "909-985-7844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST",
            "address_2": "SUITE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-985-5784",
            "fax_number": "909-985-7844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUA",
        "first_name": "JESUS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A50698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A506980",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497955132",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.