FACULTY PHYSICIANS AND SURGEONS OF LLUSM — NPI 1053361444 (Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) in SUN CITY, CA)

CMS-1500 Box 24J / 33a • NPI

1053361444

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207N00000X (CMS 07)

Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)

Box 32 Service Location & ZIP+4

28125 BRADLEY RD, SUN CITY, CA, 92586-2248

✓ 9-Digit EDI 837 ZIP+4 (92586-2248)

Practice Phone & Referral Fax

(951) 672-1931

Fax: (909) 558-3905

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053361444 (FACULTY PHYSICIANS AND SURGEONS OF LLUSM) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053361444` (NPI-2 Organization / Facility)
Provider / Legal Name	FACULTY PHYSICIANS AND SURGEONS OF LLUSM
Plain-English Specialty	Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) NUCC Code: `207N00000X` (Dermatology)
Certifying / Licensing Body	American Board of Dermatology (ABD)
Practice Location Address	28125 BRADLEY RD, SUN CITY, CA, 92586-2248
Practice Telephone / Fax	Tel: (951) 672-1931 \| Fax: (909) 558-3905
Administrative Mailing Address	FILE NUMBER 54701, LOS ANGELES, CA, 90074-0001
Enumeration & Last Sync	Enumerated: 2006-05-10 \| CMS Record Updated: 2019-07-19
Authorized Official	RICARDO PEVERINI (PRESIDENT)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

28125 BRADLEY RD, SUN CITY, CA, 92586-2248

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Plain-English Taxonomy & CMS Crosswalk (207N00000X)

What Does Taxonomy Code 207N00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207N00000X translates to:
"Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 07 (Physician/Dermatology)
Certifying / Accrediting Authority: American Board of Dermatology (ABD)
Clinical Scope: Changing moles, skin rashes, severe acne, eczema, psoriasis, fungal infections, hair loss, or skin cancer checks.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FACULTY PHYSICIANS AND SURGEONS OF LLUSM)

Typical CPT / Diagnostic Procedures:

Full-Body Dermoscopy & Skin Cancer Screening
Shave, Punch & Excisional Skin Biopsy (CPT 11102–11107)
Cryotherapy Destruction of Actinic Keratoses & Viral Warts (CPT 17000)

Common Therapeutic Classes:

Topical Corticosteroids (Triamcinolone, Clobetasol) & Calcineurin Inhibitors
Topical & Oral Retinoids (Tretinoin, Adapalene, Isotretinoin)
Doxycycline, Minocycline & Antifungals (Terbinafine, Ketoconazole)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207N00000X` — Dermatology Plain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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FACULTY PHYSICIANS AND SURGEONS OF LLUSM (NPI #1053361444)