NPIMap

Organization Active NPI

Beaver Medical Group P C

Doing business as Beaver Advantage Health Center

  • Family Medicine Physician
  • Redlands, CA
National Provider Identifier
1275570830
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BEAVER MEDICAL GROUP P C
Doing business as
Beaver Advantage Health Center
Practice address
1600 E Citrus Ave
Suite # a
Redlands, CA 92374-4270
Phone
(909) 794-3682
Fax
(909) 796-4158
NPI assigned
Jun 1, 2006
Reactivated
Nov 9, 2012
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director
Phone
(702) 480-2550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

1600 E Citrus Ave
Suite # a
Redlands, CA 92374-4270

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 480-2550

Other names 1

  • Beaver Advantage Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130110000638 CA DME Supplier - Multi-Specialty - Physician 0547164295 Practice locations: Redlands, CA

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1051694Beaver Advantage Health Center1600 E Citrus Ave, Redlands, CA 92374Provider-performed microscopyMar 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Redlands Ucc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 210

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.

View all 210

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1275570830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-480-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E CITRUS AVE",
            "address_2": "SUITE # A",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744270",
            "telephone_number": "909-794-3682",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER MEDICAL GROUP P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "deactivation_date": "2009-09-10",
        "reactivation_date": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaver Advantage Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaver Advantage Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.