FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1316997174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316997174 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
4646 Brockton Ave Riverside CA 92506-0102 |
| Mailing Address |
File Number 54701 Los Angeles CA 90074-0001 |
| Practice Telephone | 7603415570 |
| Practice Fax Number | 9095583905 |
| Mailing Telephone | 9095583111 |
| Mailing Fax Number | 9095583905 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-07-19 |
| Authorized Official Name | RICARDO PEVERINI (PRESIDENT) |
| Authorized Official Telephone | 9095587448 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR006902W | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144477 | Faculty Physicians and Surgeons of Llusm | Neurological Surgery | 35400 Bob Hope Dr Ste 110, Rancho Mirage, CA 92270-1772 | 2020-11-04 |
| 1700495363 | Faculty Physicians and Surgeons of Llusm | Radiology | 1850 N Riverside Ave Ste 160, Rialto, CA 92376-8056 | 2020-07-29 |
| 1326665415 | Faculty Physicians and Surgeons of Llusm | Otolaryngology | 4646 Brockton Ave Ste 103, Riverside, CA 92506-0103 | 2020-07-06 |
| 1790326825 | Faculty Physicians and Surgeons of Llusm | Urology | 11360 Mt View Ave Ste B, Loma Linda, CA 92354-3834 | 2019-09-30 |
| 1932600335 | Faculty Physicians and Surgeons of Llusm | Internal Medicine | 1200 California St Ste 270, Redlands, CA 92374-2970 | 2018-02-22 |
| 1386162949 | Faculty Physicians and Surgeons of Llusm | Internal Medicine | 197 E Caroline St, San Bernardino, CA 92408 | 2017-09-05 |
| 1588034169 | Faculty Physicians and Surgeons of Llusm | Physician Assistant | 350 S Euclid Ave, Unit C, Upland, CA 91786-6665 | 2015-09-25 |
| 1912343104 | Faculty Physicians and Surgeons of Llusm | Pediatrics | 1101 N Euclid Ave, Upland, CA 91786-3233 | 2013-05-15 |
| 1457680530 | Faculty Physicians and Surgeons of Llusm | Pediatrics | 12021 Jacaranda Ave., Hesperia, CA 92345-4956 | 2009-12-18 |
| 1265686109 | Faculty Physicians and Surgeons of Llusm | Pathology | 11234 Anderson St Ste 1617, Loma Linda, CA 92354-2804 | 2008-11-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FACULTY PHYSICIANS AND SURGEONS OF LLUSM | 11370 Anderson St, Loma Linda, CA 92354-3450 |
| Street Address |
4646 BROCKTON AVE |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92506-0102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730187881 | Gary Mitchell Feinberg | Otolaryngology | 4646 Brockton Ave, Suite 201, Riverside, CA 92506 | 2005-07-12 |
| 1871108381 | Physician Management Services of California, LLC | Family Medicine | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2020-09-11 |
| 1902361389 | Glenda Lee Conley | Pharmacist | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2019-02-09 |
| 1255867834 | Linnea Hondorp | Registered Nurse | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2017-05-02 |
| 1497299549 | Maria Soledad Ascencio | Nurse Practitioner | 4646 Brockton Ave, # 301, Riverside, CA 92506-0102 | 2016-12-08 |
| 1538610548 | Raincross Medical Group | Nurse Practitioner | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2016-10-14 |
| 1306201157 | Sheila Marie Stephens | Physician Assistant | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2015-12-21 |
| 1447659370 | Mary Elizabeth Barba | Nurse Practitioner | 4646 Brockton Ave, Riverside, CA 92506-0102 | 2014-08-15 |
| 1194145771 | Gary M. Feinberg Ent, Inc. | Otolaryngology | 4646 Brockton Ave, Suite 201, Riverside, CA 92506 | 2014-04-22 |
| 1477806727 | Ashley Kristen Goodacre | Physician Assistant | 4646 Brockton Ave, Suite 302, Riverside, CA 92506-0102 | 2012-10-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902405715 | Riverside Primary Care Clinic, Joanna Ayala Md | Clinic/Center | 3978 Merrill Ave, Riverside, CA 92506 | 2020-10-22 |
| 1336747005 | Beatriz Arredondo | Behavioral Analyst | 6117 Brockton Avenue Ste. 202, Riverside, CA 92506 | 2020-10-14 |
| 1740756782 | Priscilla Marie Rodriguez | Social Worker | 3742 Tibbets St Suite 201, Riverside, CA 92506 | 2018-10-17 |
| 1922593946 | Prevail Health Solutions, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 7450 Chateau Ridge Ln, Riverside, CA 92506 | 2018-06-22 |
| 1831691880 | Mckinley Children's Center | Community/Behavioral Health | 6700 Indiana Avenue, Suite 280, Riverside, CA 92506 | 2018-03-06 |
| 1720590946 | Leticia Dilworth | Behavioral Analyst | 3610 Central Ave Ste 46, Riverside, CA 92506 | 2017-10-27 |
| 1548771736 | Usa Biosciences LLC | Clinical Medical Laboratory | 5750 Division St Ste 109, Riverside, CA 92506 | 2017-10-16 |
| 1922542273 | Yazmar Sevilla-perez | Physical Therapist | 6852 Brockton Ave., Suite 212, Riverside, CA 92506 | 2016-12-06 |
| 1821547605 | Pathway To Healing, Marriage and Family Therapy, Inc. | Marriage & Family Therapist | 5790 Magnolia Ave., Ste 202, Rm F, Riverside, CA 92506 | 2016-09-22 |
| 1952857542 | Kramer and Nguyen Dental Corporation | Dentist | 3602 Riverside Plaza Dr, Ste 101, Riverside, CA 92506 | 2016-09-01 |
| Find all providers in zip 92506 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760772131 | Nikhil Sahasrabudhe | Neurological Surgery | 4500 Brockton Ave Ste 201, Riverside, CA 92501 | 2011-04-19 |
| 1215952676 | Emad Samir Farag | Neurological Surgery | 7117 Brockton Ave Ste 200, Riverside, CA 92506-2658 | 2006-07-13 |
| 1932166485 | Clifford Carl Douglas | Neurological Surgery | 4500 Brockton Avenue, Suite 201, Riverside, CA 92501-4008 | 2006-04-27 |
| 1750607099 | Sean William Kaloostian | Neurological Surgery | 6276 River Crest Dr, Ste A, Riverside, CA 92507 | 2010-04-12 |
| 1336353341 | Dennis E Cramer | Neurological Surgery | 6276 River Crest Dr, Riverside, CA 92507-0783 | 2007-05-09 |
| 1982662904 | Lawrence Erwin Clark | Neurological Surgery | 7117 Brockton Ave, Riverside, CA 92506-2658 | 2006-05-01 |
| 1154389179 | Stephen S. Marvin | Neurological Surgery | 4000 14th St, 302, Riverside, CA 92501-4083 | 2006-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144477 | Faculty Physicians and Surgeons of Llusm | Neurological Surgery | 35400 Bob Hope Dr Ste 110, Rancho Mirage, CA 92270-1772 | 2020-11-04 |
| 1013524123 | Hubert Tsun-yin Lee | Neurological Surgery | 1201 Welch Road, Stanford, CA 94305-5327 | 2020-09-24 |
| 1811500267 | Chaparral Medical Group, Inc. | Neurological Surgery | 9120 Haven Ave Ste 201, Rancho Cucamonga, CA 91730-5413 | 2020-08-26 |
| 1982259461 | Mauricio Mandel Brigido | Neurological Surgery | 300 Pasteur Dr # R281, Stanford, CA 94305-2200 | 2019-08-01 |
| 1538713227 | Sylvain Palmer Md Inc | Neurological Surgery | 26732 Crown Valley Pkwy Ste 541, Mission Viejo, CA 92691-6376 | 2019-07-31 |
| 1851945877 | X.sean Xin, Do Inc. | Neurological Surgery | 7230 Med Ctr Dr Ste 600, West Hills, CA 91307-4017 | 2019-07-29 |
| 1154974525 | Jan M. Eckermann, Md Inc. | Neurological Surgery | 1617 W Cliff Dr, Ste 203, Newport Beach, CA 92660 | 2019-07-24 |
| 1598317711 | Newport Beach Neurosurgical Institute | Neurological Surgery | 1501 Superior Ave Ste 214b, Newport Beach, CA 92663-3600 | 2019-07-09 |
| 1609438761 | Py26 Neurosurgery, PC | Neurological Surgery | 120 S Spalding Dr Ste 305, Beverly Hills, CA 90212-1800 | 2019-06-28 |
| 1679133664 | Sequoia Neurosurgery, Inc. | Neurological Surgery | 306 N Conyer St Ste A, Visalia, CA 93291-4704 | 2019-06-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.