Pacific Coast Podiatry PC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

E4834 Issued in CA

Legal business name

PACIFIC COAST PODIATRY PC

Practice address

1762 N Waterman Ave
San Bernardino, CA 92404-5130

Phone

(909) 886-3668

Fax

(909) 886-5542

NPI assigned

May 11, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Clayton Gary Johnsen, D.P.MNPI 1003141318

Title

Owner

Phone

(909) 886-3668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clayton Gary Johnsen, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • San Bernardino, CA
  • NPI 1003141318
  Medicare reassignment Care Compare group Authorized official
• Shazeb Ali Rizvi, DPM

  • Podiatrist
  • San Bernardino, CA
  • NPI 1760003453
  Medicare reassignment Care Compare group
• John M Stutz, DPM

  • Foot & Ankle Surgery Podiatrist
  • Fontana, CA
  • NPI 1689733396
  Medicare reassignment Care Compare group
• Erin N Vogtman, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • San Bernardino, CA
  • NPI 1982923306
  Medicare reassignment Care Compare group
• Scott Crismon, D.P.M.

  • Sports Medicine Podiatrist
  • Los Angeles, CA
  • NPI 1679872725
  Medicare reassignment
• James Sperber, M.D.

  • Internal Medicine Physician
  • San Clemente, CA
  • NPI 1518922236
  NPD (past)

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1285080978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1762 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045130",
            "telephone_number": "909-886-3668",
            "fax_number": "909-886-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1762 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045130",
            "telephone_number": "909-886-3668",
            "fax_number": "909-886-5542"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "657 Camino De Los Mares Ste 133",
            "address_purpose": "LOCATION",
            "city": "San Clemente",
            "state": "CA",
            "postal_code": "926732810",
            "country_code": "US",
            "telephone_number": "909-886-3668",
            "fax_number": "909-886-5542",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PACIFIC COAST PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-11",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSEN",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-886-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "E4834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1285080978",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lailonie Pabon
• James Bernard Pace, PHD
• Castadie Pacheco
• Elizabeth Pacheco
• Pacific Clinics
• Pacific Home Health
• Pacific Home Health Nursing, Inc.
• Pacific Hospice Inc.
• Pacific Hospice, Inc.
• Pacific Neuro Diagnostic Medical Group, Inc.

• Preferred Provider Organization in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.