FACULTY MEDICAL GROUP OF LLUSM (NPI# 1942431762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942431762 |
| Entity Type | Organization |
| Organization Name | FACULTY MEDICAL GROUP OF LLUSM |
| Other Organization Name | FACULTY MEDICAL GROUP OF LLUSM-RADIOLOGY |
| Practice Address |
11234 Anderson St Loma Linda CA 92354-2804 |
| Mailing Address |
File # 54701 Los Angeles CA 90074-4701 |
| Practice Telephone | 9095583016 |
| Mailing Telephone | 9095583111 |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2009-08-28 |
| 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 | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| FACULTY MEDICAL GROUP OF LLUSM-RADIOLOGY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952626137 | Faculty Medical Group of Llusm | Radiology | 81 Highland Springs Ave Ste 102, Beaumont, CA 92223-3170 | 2010-03-31 |
| 1386875110 | Faculty Medical Group of Llusm | Radiology | 25455 Barton Rd Ste 107b, Loma Linda, CA 92354-3139 | 2009-07-28 |
| 1497986228 | Faculty Medical Group of Llusm | Radiology | 11370 Anderson St Ste 1700, Loma Linda, CA 92354-3450 | 2009-07-28 |
| 1295781219 | Faculty Medical Group of Llusm | Transplant Surgery | 25865 Barton Rd, Ste 101, Loma Linda, CA 92354-3895 | 2006-05-25 |
| 1619314168 | Faculty Medical Group of Llusm | Transplant Surgery | 69844 Highway 111, Suite A & B, Rancho Mirage, CA 92270-2849 | 2013-05-23 |
| 1699071753 | Faculty Medical Group of Llusm | Emergency Medicine | 28078 Baxter Rd, Murrieta, CA 92563 | 2011-02-07 |
| 1659677433 | Faculty Medical Group of Llusm | Emergency Medicine | 28062 Baxter Road, Murrieta, CA 92563 | 2011-01-27 |
| 1295966026 | Faculty Medical Group of Llusm | Radiology | 25333 Barton Rd, Loma Linda, CA 92354-3123 | 2009-07-28 |
| 1124259015 | Faculty Medical Group of Llusm | Radiology | 900 E Washington St Ste 150, Colton, CA 92324-4119 | 2009-07-27 |
| 1679704563 | Faculty Medical Group of Llusm | Radiology | 26780 Barton Rd, Redlands, CA 92373-4308 | 2009-07-27 |
| Street Address |
11234 ANDERSON ST |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92354-2804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891794657 | Leigh Ann Ballou | Physician Assistant | 11234 Anderson St, Rm 2562b, Loma Linda, CA 92354-2804 | 2005-07-14 |
| 1285233759 | Daemian Alexander Martin Sr. | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-10-25 |
| 1922610450 | Samantha Zepeda Merchant | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-08-17 |
| 1609493451 | Romina Mcgalliard | Registered Nurse | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-27 |
| 1811514854 | Christopher Jihoon Kim | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-25 |
| 1912523135 | Shelly Marie Bogue | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-23 |
| 1962028613 | Sikai Song | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-18 |
| 1720604515 | Nelson Horsley | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-17 |
| 1134744055 | Teddy Matthew Mumu | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-16 |
| 1124643135 | Kristofer John Vance | Student in an Organized Health Care Education/Training Program | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2020-06-15 |
| 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 | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386875110 | Faculty Medical Group of Llusm | Radiology | 25455 Barton Rd Ste 107b, Loma Linda, CA 92354-3139 | 2009-07-28 |
| 1497986228 | Faculty Medical Group of Llusm | Radiology | 11370 Anderson St Ste 1700, Loma Linda, CA 92354-3450 | 2009-07-28 |
| 1487803946 | Erica Lynne Kinne | Radiology | 11234 Anderson St Rm 2605, Loma Linda University Medical Center, Loma Linda, CA 92354-2804 | 2008-09-09 |
| 1114930500 | Vy N. Vu | Radiology | Jerry L Pettis Memorial Center Radiology Dept, 11201 Benton Street, Loma Linda, CA 92357-0001 | 2006-08-15 |
| 1740292937 | Chih-chiang Hsu | Radiology | Vallhcs, 11201 Benton St, Loma Linda, CA 92357-0001 | 2006-08-13 |
| 1649294802 | Khin M Tint | Radiology | 114 Vamc 11201 Benton St, Loma Linda, CA 92357-0001 | 2006-07-27 |
| 1558384768 | Pradeep Badhwar | Radiology | Va Hospital 11201 Benton St, Loma Linda, CA 92357-0001 | 2006-07-26 |
| 1760421432 | Thomas J Kelly | Radiology | 11234 Anderson St Ste B623, Loma Linda, CA 92354-2804 | 2006-06-06 |
| 1558317883 | Loma Linda University Radiology Medical Group Inc | Radiology | 25333 Barton Road, Loma Linda, CA 92354 | 2006-05-26 |
| 1255396479 | Loma Linda High Field Open Mri and Diagnostic Center Inc | Radiology | 10459 Mountain View Avenue, Suite E, Loma Linda, CA 92354 | 2006-04-19 |
| 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.