FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI# 1528018553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528018553 |
| Entity Type | Organization |
| Organization Name | FACULTY PHYSICIANS AND SURGEONS OF LLUSM |
| Practice Address |
25455 Barton Rd Suite 108a Loma Linda CA 92354-3128 |
| Mailing Address |
File Number 54701 Los Angeles CA 90074-0001 |
| Practice Telephone | 9095586388 |
| 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 | GR0069021 | 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 |
25455 BARTON RD SUITE 108A |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92354-3128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124018114 | Gary D Botimer | Orthopaedic Surgery | 25455 Barton Rd, Ste 102b, Loma Linda, CA 92354-3128 | 2005-10-21 |
| 1033753249 | Victoria V Teppone | Family Medicine | 25455 Barton Rd, Loma Linda, CA 92354-3128 | 2019-10-30 |
| 1376991059 | Russell Irving Carl Erickson Iv | Student in an Organized Health Care Education/Training Program | 25455 Barton Rd, Suite 206a, Loma Linda, CA 92354-3128 | 2016-06-02 |
| 1164879219 | Megan Ashley Olivas | Registered Nurse | 25455 Barton Rd, 204b, Loma Linda, CA 92354-3128 | 2016-05-18 |
| 1407202328 | Tiffiny Suzanne Pizzifred | Nurse Practitioner | 25455 Barton Rd, Suite 204b, Loma Linda, CA 92354-3128 | 2016-05-10 |
| 1679943054 | Rio Gutierrez Ocampo | Nurse Practitioner | 25455 Barton Rd, Suite 204b, Loma Linda, CA 92354-3128 | 2015-09-29 |
| 1164806329 | Mark R Weber | Physician Assistant | 25455 Barton Rd, Loma Linda, CA 92354-3128 | 2015-07-16 |
| 1457731572 | Mopelola Adetola Adeyemo | Internal Medicine | 25455 Barton Rd, Suite 206-a, Loma Linda, CA 92354-3128 | 2015-06-03 |
| 1073991287 | Micah Clement | Physician Assistant | 25455 Barton Rd, Loma Linda, CA 92354-3128 | 2015-05-08 |
| 1952713802 | Jack Pierre Dubois | Family Medicine | 25455 Barton Rd, Loma Linda, CA 92354 | 2014-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264337 | Apple Red Nutrition Services | Dietitian, Registered | 357 W. 2nd St, Suite #2, Loma Linda, CA 92354 | 2020-10-30 |
| 1013517960 | Kristina Pulliam Markey | Nurse Practitioner | 11234 Anderson Strreet, Loma Linda, CA 92354 | 2020-10-29 |
| 1932725645 | Dev Priya Singhvi | Student in an Organized Health Care Education/Training Program | 11332 Mountain View Avenue, Westerly Building, Suite C, Gme Office, Loma Linda, CA 92354 | 2020-06-18 |
| 1750901278 | Angela N Torres | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Emergency Medicine, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-04-24 |
| 1548899230 | Holistic Physical Therapy Inc. | Physical Therapist | 25003 Starr Str, Loma Linda, CA 92354 | 2020-04-03 |
| 1508494071 | Eric Allen | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Pediatrics, General, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-03-31 |
| 1730640244 | Rose Valley Rcfe | Assisted Living Facility | 11574 Poplar St, Loma Linda, CA 92354 | 2019-03-27 |
| 1336633676 | David A Lawrence | Student in an Organized Health Care Education/Training Program | Loma Linda University Hospital, 11234 Anderson St., Loma Linda, CA 92354 | 2018-06-20 |
| 1205329547 | Rachael Nicole Spady | Student in an Organized Health Care Education/Training Program | Loma Linda University Health - Obstetrics & Gynecology, 11234 Anderson St, Loma Linda, CA 92354 | 2018-06-12 |
| 1447756069 | Anthony Ernest Sanchez | Otolaryngology | 11332 Mountain View, Westerly Building Suite C, Loma Linda, CA 92354 | 2018-04-03 |
| Find all providers in zip 92354 | ||||
| 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 |
|---|---|---|---|---|
| 1275783276 | Achal Singh Achrol | Neurological Surgery | 11234 Anderson St Rm 2562-b, Loma Linda, CA 92354-2804 | 2008-09-25 |
| 1821181553 | Huitzilin Mauricio Olmecah | Neurological Surgery | 11175 Campus St, Department of Neurology, Coleman Pavilion - Rm. 11108, Loma Linda, CA 92350-1700 | 2006-10-02 |
| 1912007790 | Warren Boling | Neurological Surgery | 11234 Anderson St Rm 2562b, Loma Linda, CA 92354-2804 | 2006-09-22 |
| 1164719365 | Anish Neeraj Sen | Neurological Surgery | 25455 Barton Rd Ste 108a, Loma Linda, CA 92354 | 2011-07-07 |
| 1306137625 | Brian E. William Hanak Iv | Neurological Surgery | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2011-04-20 |
| 1609188747 | Tanya Minasian | Neurological Surgery | 11234 Anderson St Rm 2562b, Loma Linda, CA 92354-2804 | 2010-07-06 |
| 1629212535 | Justin Dye | Neurological Surgery | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2009-04-22 |
| 1891938817 | Esther Jihae Kim | Neurological Surgery | 11234 Anderson St, House Staff Office Cp 21005, Loma Linda, CA 92354-2804 | 2009-04-07 |
| 1376783068 | Richard Aaron Robison | Neurological Surgery | 25455 Barton Rd Ste 108a, Loma Linda, CA 92354 | 2009-02-20 |
| 1851546600 | Daniel J Dilorenzo | Neurological Surgery | 25455 Barton Rd Ste 108a, Loma Linda, CA 92354-3139 | 2008-11-20 |
| Find all providers in LOMA LINDA | ||||
| City | LOMA LINDA |
| Zip Code | 92354 |
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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.