CDCR-PBSP

Primary specialty

Prison Health Clinic/CenterTaxonomy code 261QP2400X

License

A043460 Issued in CA

Legal business name

CDCR-PBSP

Practice address

5905 Lake Earl Dr
Crescent City, CA 95532-0001

Phone

(707) 465-1000

NPI assigned

Mar 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maureen McLeanNPI 1508089079

Title

Health Care Manager

Phone

(707) 465-1000

Specialties & licenses 1

Addresses

Other names 1

• Pelican Bay State Prison Other name

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

CLIA laboratory certificates

Practitioners 3

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.

• Maureen McLean, FNP

  • Family Nurse Practitioner
  • Crescent City, CA
  • NPI 1508089079
  Authorized official Same address or phone
• Masoumeh Zinat Razavi, PHD

  • Clinical Psychologist
  • Crescent City, CA
  • NPI 1023219128
  NPD (past)
• Laurina Yu, PH.D.

  • Clinical Psychologist
  • Crescent City, CA
  • NPI 1871830513
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437280153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7000",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955320001",
            "telephone_number": "707-465-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 LAKE EARL DR",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955320001",
            "telephone_number": "707-465-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDCR-PBSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCLEAN",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "HEALTH CARE MANAGER",
        "authorized_official_telephone_number": "707-465-1000"
    },
    "taxonomies": [
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "CA",
            "license": "A043460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelican Bay State Prison",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diane Cantrell
• Vincent Anthony Cappello, LCSW
• Annette Marie Carlsen, PA
• Shelagh Carrick, LM
• Dyan Lisabeth Carver, RN
• Cecilia Patton Chiropractic a Professional Corporation (Fine Spine Chiropractic Office)
• Zachary Michael Centner
• Cep America-California
• Kelly Renee Chaffee
• Bruce L Chambers

• Prison Health Clinic/Center in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Prison Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.