NPIMap

Individual provider Active NPI

Clifton A Mayberry, MD

  • Specialist
  • Pasadena, CA
National Provider Identifier
1063543056
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G43796 Issued in CA
Practice address
2750 E Washington Blvd
Ste 330
Pasadena, CA 91107-1448
Phone
(626) 797-9883
Fax
(626) 797-9853
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G43796 CA Primary

Addresses

Primary practice location

2750 E Washington Blvd
Ste 330
Pasadena, CA 91107-1448

Mailing address

2750 E Washington Blvd
Ste 330
Pasadena, CA 91107-1448
Phone (626) 797-9883

Other identifiers 2

IdentifierTypeStateIssuer
GR0029750MedicaidCA
100002889OtherCARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G43796CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Glendale Adventist Medical Center Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Ahmc San Gabriel Valley Medical Past Accepting new patients
Pasadena Hospital Association, LTD. Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1063543056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 E WASHINGTON BLVD",
            "address_2": "STE 330",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071448",
            "telephone_number": "626-797-9883",
            "fax_number": "626-797-9853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 E WASHINGTON BLVD",
            "address_2": "STE 330",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071448",
            "telephone_number": "626-797-9883",
            "fax_number": "626-797-9853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "CLIFTON",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G43796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0029750",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100002889",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.