BEAVER MEDICAL GROUP LP (NPI# 1639344716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639344716 |
| Entity Type | Organization |
| Organization Name | BEAVER MEDICAL GROUP LP |
| Other Organization Name | BEAVER MEDICAL GROUP - HIGHLAND EXTENDED CARE |
| Practice Address |
7000 Boulder Ave Highland CA 92346-3348 |
| Mailing Address |
9276 Scranton Rd Suite 100 San Diego CA 92121-7701 |
| Practice Telephone | 9098621191 |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2016-06-09 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | A69210 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| Beaver Medical Group - Highland Extended Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629482641 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 81 Highland Springs Ave, Suite 200, Beaumont, CA 92223-3170 | 2014-06-18 |
| 1578991816 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 2 W Fern Ave, Suite 200, Redlands, CA 92373-5916 | 2013-10-24 |
| 1881857597 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 6109 W Ramsey St, Banning, CA 92220-3051 | 2008-07-03 |
| 1831377662 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2008-02-04 |
| 1205013323 | Beaver Medical Group Lp | Optometrist | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2008-01-31 |
| Street Address |
7000 BOULDER AVE |
| City | HIGHLAND |
| State | CA |
| Zip Code | 92346-3348 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568412567 | Hin Wah Lee | Internal Medicine | 7000 Boulder Ave, Highland, CA 92346-3348 | 2006-05-11 |
| 1932757374 | Roger Rosewitz | Nurse Practitioner | 7000 Boulder Ave, Highland, CA 92346-3348 | 2019-08-29 |
| 1003383480 | Andrew Tyler | Orthopaedic Surgery | 7000 Boulder Ave, Highland, CA 92346-3348 | 2018-10-24 |
| 1306330444 | Charlene De Grassi | Nurse Practitioner | 7000 Boulder Ave, Highland, CA 92346 | 2018-06-21 |
| 1366812786 | Timothy Thue | Physician Assistant | 7000 Boulder Ave, Highland, CA 92346-3348 | 2015-09-28 |
| 1598196255 | Thaung Myat Aung | Internal Medicine | 7000 Boulder Ave, Highland, CA 92346 | 2013-12-06 |
| 1013353218 | Raymond Sedgh | Family Medicine | 7000 Boulder Ave, Highland, CA 92346-3348 | 2013-05-14 |
| 1730524067 | Michael Joseph Mcneill | Family Medicine | 7000 Boulder Ave, Highland, CA 92346 | 2013-04-30 |
| 1407142201 | Mohamed Sami Elsharif | Psychiatry & Neurology | 7000 Boulder Ave, Highland, CA 92346-3348 | 2011-06-21 |
| 1427341577 | Ankona Ghosh | Otolaryngology | 7000 Boulder Ave, Highland, CA 92346-3348 | 2011-05-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972101830 | First Choice Transport Services LLC | Non-emergency Medical Transport (VAN) | 7538 Bonita Dr, Highland, CA 92346 | 2020-10-13 |
| 1578031597 | Highland Optometrics | Optometrist | 7291 Boulder Avenue Suite #2d, Highland, CA 92346 | 2018-11-07 |
| 1972098218 | Hlh Wellness | Health Educator | 7758 Merlin Way, Highland, CA 92346 | 2018-06-28 |
| 1871088385 | Alexandria Ramirez | Behavioral Analyst | 7566 Rock Crest Lane, Highland, CA 92346 | 2018-06-27 |
| 1942708383 | Sarah Kristine Alcaide Young | Nurse Practitioner | 7223 Church St Ste C, Highland, CA 92346 | 2018-01-31 |
| 1861914251 | Brianna Rose Delpilar | Pharmacist | 2692 Highland Ave., Spc. 20, Highland, CA 92346 | 2017-07-07 |
| 1811440894 | Nancy Elizabeth Clark | Counselor | 29157 Stonegate Lane, Highland, CA 92346 | 2016-07-26 |
| 1952771529 | Michael Woosley | Physical Therapy Assistant | 29176 Whitegate Ln., Hihgland, CA 92346 | 2015-09-25 |
| 1326422940 | Lawryn Ask Monterroso | Dentist | 7216 Palm Avenue Suit B, Highland, CA 92346 | 2015-07-14 |
| 1073908315 | Empacare Homecare | Hospice, Inpatient | 7231 Boulder Ave., Ste 197, Highland, CA 92346 | 2015-04-03 |
| Find all providers in zip 92346 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
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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.