NPIMap

Organization Active NPI

Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
National Provider Identifier
1427090281
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BEAVER MEDICAL GROUP P C
Practice address
245 Terracina Blvd
Suite # 105
Redlands, CA 92373-4852
Phone
(909) 792-9737
Fax
(909) 796-4158
NPI assigned
Jun 13, 2006
Reactivated
Nov 9, 2012
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

245 Terracina Blvd
Suite # 105
Redlands, CA 92373-4852

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ42611ZOtherMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131022002242 CA DME Supplier - Multi-Specialty - PhysicianDME Supplier - Independently-Practicing Physical Therapist 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).

National Provider Directory

National Provider Directory

Locations

81 Highland Springs Ave
Beaumont, CA 92223
Phone (909) 558-3016

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

7223 Church St
Ste C
Highland, CA 92346

2067 W Vista Way
Ste 280
Vista, CA 92083
Phone (760) 941-1440

Practitioners & affiliated clinicians

Practitioners 668

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 668

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1427090281",
    "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": "245 TERRACINA BLVD",
            "address_2": "SUITE # 105",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734852",
            "telephone_number": "909-792-9737",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER MEDICAL GROUP P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "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": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ42611Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 3, 2024; 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.