NPIMap

Organization Active NPI

Beach Physicians Medical Group Inc

  • Family Medicine Physician
  • Huntington Beach, CA
National Provider Identifier
1366439200
Registry record updated Jan 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BEACH PHYSICIANS MEDICAL GROUP INC
Practice address
17742 Beach Blvd
Ste 215
Huntington Beach, CA 92647-6818
Phone
(714) 848-1655
Fax
(714) 847-4348
NPI assigned
Oct 5, 2005
Last updated
Jan 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2010

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

Authorized official

Name
Arnold J Brender, MDNPI 1396732053
Title
President
Phone
(714) 848-1655

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

17742 Beach Blvd
Ste 215
Huntington Beach, CA 92647-6818

Mailing address

17742 Beach Blvd
Ste 215
Huntington Beach, CA 92647-6818
Phone (714) 848-1655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000748 CA Part B Supplier - Clinic/Group Practice 9133017049 Receives reassigned benefits from 6 practitioners
Practice locations: Huntington Beach, CA
O20100930021792 CA DME Supplier - Physician - General PracticeDME Supplier - Sports Medicine 9133017049 Practice locations: Huntington Beach, CA

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
05D0577401Beach Physicians Medical Group, Inc17742 Beach Blvd Ste 215, Huntington Beach, CA 92647Certificate of waiverApr 28, 2027

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 12

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": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262649600000",
    "number": "1366439200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17742 BEACH BLVD",
            "address_2": "STE 215",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476818",
            "telephone_number": "714-848-1655",
            "fax_number": "714-847-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17742 BEACH BLVD",
            "address_2": "STE 215",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476818",
            "telephone_number": "714-848-1655",
            "fax_number": "714-847-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH PHYSICIANS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2010-01-05",
        "status": "A",
        "authorized_official_last_name": "BRENDER",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-848-1655",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; 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.