NPIMap

Organization Active NPI

Thrive Health IV Clinic PC

  • Multi-Specialty Clinic/Center
  • Rancho Palos Verdes, CA
National Provider Identifier
1043193972
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
THRIVE HEALTH IV CLINIC PC
Practice address
28633 S Western Ave Ste 202
Rancho Palos Verdes, CA 90275-0817
Phone
(310) 363-8757
Fax
(310) 363-8758
NPI assigned
Jul 29, 2025
Last updated
Jul 29, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THRIVE HEALTH IV CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raymond S Douglas, MD, PHDNPI 1124041959
Title
President
Phone
(310) 657-4302

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X NU
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

28633 S Western Ave Ste 202
Rancho Palos Verdes, CA 90275-0817

Mailing address

9675 Brighton Way Ste 410
Beverly Hills, CA 90210-5192
Phone (310) 363-8757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230622000890 CA Part B Supplier - Clinic/Group Practice 0941668057 Receives reassigned benefits from 10 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sherman Oaks, CA; Beverly Hills, CA; Santa Monica, CA; Rancho Palos Verdes, CA; Long Beach, CA; Newport Beach, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Thrive Health IV CLN PC15 organizations share this tax ID, including this one
Part of
Thrive Health IV CLN PC

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

28633 S Western Ave
Ste 202
Rancho Palos Verdes, CA 90275
Phone (310) 241-0947

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1043193972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY STE 410",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105192",
            "telephone_number": "310-363-8757",
            "fax_number": "310-363-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28633 S WESTERN AVE STE 202",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902750817",
            "telephone_number": "310-363-8757",
            "fax_number": "310-363-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE HEALTH IV CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THRIVE HEALTH IV CLINIC PC",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-657-4302",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Palos Verdes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.