BEAVER MEDICAL GROUP LP (NPI# 1881857597) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881857597 |
| Entity Type | Organization |
| Organization Name | BEAVER MEDICAL GROUP LP |
| Other Organization Name | BEAVER MEDICAL GROUP - BANNING EXTENDED CARE |
| Practice Address |
6109 W Ramsey St Banning CA 92220-3051 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 9518450313 |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2013-04-25 |
| 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 | C51632 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| Beaver Medical Group - Banning 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 |
| 1639344716 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 7000 Boulder Ave, Highland, CA 92346-3348 | 2008-04-29 |
| 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 |
6109 W RAMSEY ST |
| City | BANNING |
| State | CA |
| Zip Code | 92220-3051 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952305294 | Steven W Hildebrand | Internal Medicine | 6109 W Ramsey St, Banning, CA 92220-3051 | 2005-06-01 |
| 1134609415 | Carri Ranie Lakes | Registered Nurse | 6109 W Ramsey St, Banning, CA 92220-3051 | 2018-08-16 |
| 1316331838 | Yi Heng | Registered Nurse | 6109 W Ramsey St, Banning, CA 92220-3051 | 2015-03-23 |
| 1316365521 | Brandon Decaluwe | Ophthalmology | 6109 W Ramsey St, Banning, CA 92220-3051 | 2014-04-03 |
| 1962834499 | Stephanie Salazar | Nurse Practitioner | 6109 W Ramsey St, Banning, CA 92220-3051 | 2013-08-07 |
| 1902151277 | Julie Smits | Registered Nurse | 6109 W Ramsey St, Banning, CA 92220-3051 | 2012-07-23 |
| 1326356908 | Kelly Marie Stormes | Nurse Practitioner | 6109 W Ramsey St, Banning, CA 92220-3051 | 2010-09-17 |
| 1801129341 | Kaunteya Reddy | Internal Medicine | 6109 W Ramsey St, Banning, CA 92220-3051 | 2009-09-16 |
| 1487896783 | Craig Andre Seheult | Internal Medicine | 6109 W Ramsey St, Banning, CA 92220 | 2009-04-01 |
| 1912180233 | Bahij Ghazal | Internal Medicine | 6109 W Ramsey St, Banning, CA 92220-3051 | 2007-12-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962056523 | Golden View Guest Home, Inc. | Assisted Living Facility | 5466 West Wilson, Banning, CA 92220 | 2019-07-31 |
| 1780246157 | Fjs Hearing Professionals | Hearing Instrument Specialist | 3559 W Ramsey Ave Suit C-2, Banning, CA 92220 | 2019-07-05 |
| 1790237832 | Jennifer De Geus | Counselor | 1627 Hargrave St., Banning, CA 92220 | 2016-10-25 |
| 1427447507 | Dalonna Blackwell | Counselor | 2781 W. Ramsey St., Banning, CA 92220 | 2015-01-13 |
| 1639575962 | Eunjung J. Jung Choi | Dentist | 300 S Highland Springs Ave Ste 2l, Banning, CA 92220 | 2014-11-13 |
| 1861810244 | Genevra Diana Glenn | Counselor | 2781 W Ramsey, Suite 1, Banning, CA 92220 | 2014-04-02 |
| 1841617420 | Kristen Lew | Internal Medicine | 6109 W.ramsey Street, Banning, CA 92220 | 2014-03-21 |
| 1588917884 | Jamison William Murphy | Military Health Care Provider | Uss Howard Ddg 83, Fpo, AP 92220 | 2012-10-24 |
| 1972871390 | John Hong | Pharmacist | 60 N Highlandsprings, Beaumont, CA 92220 | 2011-12-13 |
| 1679855936 | Lydia Session | Marriage & Family Therapist | 1627 S. Hargrave, Banning, CA 92220 | 2011-09-13 |
| Find all providers in zip 92220 | ||||
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437564143 | Beaver Medical Group Ramsey Primary | Non-Pharmacy Dispensing Site | 5957 W Ramsey St, Second Floor Pod D, Banning, CA 92220-3058 | 2014-06-23 |
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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.