BEAVER MEDICAL GROUP, LP (NPI# 1275570830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275570830 |
| Entity Type | Organization |
| Organization Name | BEAVER MEDICAL GROUP, LP |
| Other Organization Name | BEAVER ADVANTAGE HEALTH CENTER |
| Practice Address |
1600 E Citrus Ave Suite # A Redlands CA 92374-4270 |
| Mailing Address |
Po Box 10069 San Bernardino CA 92423-0069 |
| Practice Telephone | 9097943682 |
| Practice Fax Number | 9097964158 |
| Mailing Telephone | 9093354188 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2020-02-19 |
| NPI Deactivation Date | 09/10/2009 |
| NPI Reactivation Date | 2012-11-09 |
| Authorized Official Name | CHARLES T CHEN (SENIOR MEDICAL DIRECTOR) |
| Authorized Official Telephone | 0979333119 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEAVER MEDICAL GROUP, LP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Beaver Advantage Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326085663 | Beaver Medical Group, Lp | Orthopaedic Surgery | 259 Terracina Blvd, Redlands, CA 92373-4847 | 2006-06-02 |
| 1457372179 | Beaver Medical Group, Lp | Family Medicine | 5957 W Ramsey St, Banning, CA 92220-3058 | 2006-07-21 |
| 1346278363 | Beaver Medical Group, Lp | Internal Medicine | 7223 Church St, Ste C, Highland, CA 92346-5869 | 2006-06-29 |
| 1144265919 | Beaver Medical Group, Lp | Optometrist | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2006-06-17 |
| 1831133768 | Beaver Medical Group, Lp | Allergy & Immunology | 2 W Fern Ave, Redlands, CA 92373-5916 | 2006-06-14 |
| 1427090281 | Beaver Medical Group, Lp | Physical Therapist | 245 Terracina Blvd, Suite # 105, Redlands, CA 92373-4852 | 2006-06-13 |
| 1598706293 | Beaver Medical Group, Lp | Dermatology | 7000 Boulder Ave, Highland, CA 92346-3348 | 2006-06-10 |
| 1619914959 | Beaver Medical Group, Lp | Optometrist | 6109 W Ramsey St, Banning, CA 92220-3051 | 2006-06-02 |
| Street Address |
1600 E CITRUS AVE SUITE # A |
| City | REDLANDS |
| State | CA |
| Zip Code | 92374-4270 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013994102 | Katrina Carter | Family Medicine | 1600 E Citrus Ave, Redlands, CA 92374-4270 | 2005-12-29 |
| 1134549884 | Amy Blackmon | Internal Medicine | 1600 E Citrus Ave, Redlands, CA 92374-4270 | 2014-04-21 |
| 1568773448 | Xu Long He | Internal Medicine | 1600 E Citrus Ave, Suite A, Redlands, CA 92374-4270 | 2010-06-25 |
| 1295834273 | Jana Lynn Webb | Pediatrics | 1600 E Citrus Ave, Redlands, CA 92374-4270 | 2006-09-22 |
| 1679678916 | Rubin C Lin | Family Medicine | 1600 E Citrus Ave, Redlands, CA 92374-4270 | 2006-09-13 |
| 1811001506 | Priya Malik | Internal Medicine | 1600 E Citrus Ave, Ste A, Redlands, CA 92374-4270 | 2006-08-18 |
| 1114946340 | Mouna Haddad-wilson | Internal Medicine | 1600 E Citrus Ave, Suite A, Redlands, CA 92374-4270 | 2006-07-19 |
| 1366484362 | Gregory M. Jones | Family Medicine | 1600 E Citrus Ave, Ste., A, Redlands, CA 92374-4270 | 2006-06-12 |
| 1740229293 | Michael A. Wilson | Internal Medicine | 1600 E Citrus Ave, Ste A, Redlands, CA 92374-4270 | 2006-06-06 |
| 1467499616 | Michelle A Anderson | Pediatrics | 1600 E Citrus Ave, Suite A, Redlands, CA 92374-4270 | 2006-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053802652 | V Rana Dds Inc | Clinic/Center | 1748 E Lugonia Ave Ste 126, Redlands, CA 92374 | 2018-05-21 |
| 1467979393 | Brianna Ashley Torres | Behavioral Analyst | 1467 Stillman Ave, Redlands, CA 92374 | 2017-08-22 |
| 1851821953 | Veronica Esqueda | Social Worker | 21 Crafton Ct, Redlands, CA 92374 | 2017-06-13 |
| 1053855783 | Caroline Daravi | Psychologist | 1706 Plum Lane #110, Redland, CA 92374 | 2016-12-14 |
| 1487092722 | Kathryn Wheeler | Speech-Language Pathologist | 112 Eleventh Street, Redlands, CA 92374 | 2013-06-10 |
| 1275979254 | Lifecare Solutions Inc | Durable Medical Equipment & Medical Supplies | 1220 Research Dr, Redlands, CA 92374 | 2013-05-16 |
| 1639515125 | Shantrice Nicole Burton | Speech-Language Pathologist | 1323 W Colton Ave Ste 105, Redlands, CA 92374 | 2013-05-11 |
| 1275898314 | Hrishikesh C Gogineni | Orthopaedic Surgery | 1801 Orange Tree Ln Ste 200, Redlands, CA 92374 | 2012-07-04 |
| 1609168897 | Mina Youssef | Psychiatry & Neurology | 26325 Snowden Ave, Redlands, CA 92374 | 2011-05-06 |
| 1902106545 | Jerrold Edward Hammer | Pharmacist | 422 N Orange St., Redlands, CA 92374 | 2010-10-29 |
| Find all providers in zip 92374 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710340195 | Sherri English | Family Medicine | 25828 Redlands Blvd., Suite 102, Redlands, CA 92373-8450 | 2016-04-01 |
| 1386021145 | Christen Leah Cuevas | Family Medicine | 1200 California St Ste 240, Redlands, CA 92374-2948 | 2015-04-30 |
| 1366710865 | Nathan King | Family Medicine | 1600 E. Citrus Ave, Redlands, CA 92374-4802 | 2011-12-12 |
| 1568758100 | Kauai Nicole Kennedy-eto | Family Medicine | 1711 N. Orange Street, Redlands, CA 92374-2254 | 2011-06-22 |
| 1932400645 | Charles Edward Payton | Family Medicine | 10393 Enterprise Dr, Redlands, CA 92374-4525 | 2010-11-11 |
| 1467650069 | Sophia Alexandros | Family Medicine | 951 Sunset Hills Ln, Redlands, CA 92373-6964 | 2007-07-05 |
| 1588780506 | Benny Hau | Family Medicine | 1244 W Highland Ave, Redlands, CA 92373-6659 | 2007-03-21 |
| 1750467874 | David Fukuda | Family Medicine | 721 Nevada St, Suite #406, Redlands, CA 92373-8079 | 2006-10-31 |
| 1558472464 | Alexander Terrazas | Family Medicine | 1720 Sarrita Dr, Redlands, CA 92373-7222 | 2006-08-31 |
| 1679684807 | Mohammad Moazzan Hossain | Family Medicine | 627 Brookside Ave, Redlands, CA 92373-4666 | 2006-08-31 |
| Find all providers in REDLANDS | ||||
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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.