JACK ALAN LAURIE MD
NPI 1063496545
Pediatrics in Riverside, CA

Q: What is Jack Laurie's NPI number?

The NPI number for Jack Laurie is 1063496545. It was assigned to this individual provider in the NPPES registry on November 30, 2005.

Q: What is Jack Laurie's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Laurie was last updated on November 15, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 30, 2005PECOS Enrolled

6405 DAY ST, RIVERSIDE, CA 92507(951) 697-5430(951) 697-5488 Get Directions Write a Review

NPPES record last updated: November 15, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Jack Alan Laurie Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK ALAN LAURIE MD (NPI 1063496545) is an individual pediatrics provider in Riverside, California, licensed in California (G43352) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063496545

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameJACK ALAN LAURIECredential: MD

Location Address6405 DAY STRiverside, CA 92507-0901

Mailing Address3660 Arlington AveRiverside, CA 92506-3912 · (951) 782-5110 · Fax (951) 274-0403

Phone(951) 697-5430

Fax(951) 697-5488

Sole ProprietorNo

Enumeration DateNovember 30, 2005

Last NPPES UpdateNovember 15, 2010

✔ NPI 1063496545 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in CA · G43352

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

6405 DAY ST, Riverside, CA 92507

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Other Identifiers 3

Medicare ID-Type UnspecifiedOOG433520

Medicare UPINA49319

OtherZZZ92058ZGroup Site Location

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack Alan Laurie Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jack Laurie reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Riverside Medical Clinic, Inc

Same address

Family Medicine

6405 DAY ST
Riverside, CA 92507

Reassigned Medicare billing, California enrollment
349 clinicians in this Medicare group

NPI 1780782557 (951) 683-6370

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92507 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$104.64 typical visit price

range $19.37 – $146.42

Typical copayment $26.16 (range $4.84 – $36.60)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARJORIE TERESA WIMMER MD

Internal Medicine