NPIMap

Organization Active NPI

Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1639314255
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
A73011 Issued in CA
Legal business name
SOUTHERN CALIFORNIA EMERGENCY MEDICINE
Practice address
2101 N Waterman Ave
San Bernardino, CA 92404-4836
Phone
(909) 881-4335
NPI assigned
Dec 10, 2008
Last updated
Oct 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

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

Authorized official

Name
Mr. Brian Jeffrey Bearie, M.D.NPI 1386754216
Title
Owner
Phone
(909) 596-6349

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X A73011 CA Primary

Addresses

Primary practice location

2101 N Waterman Ave
San Bernardino, CA 92404-4836

Mailing address

1407 Foothill Blvd
#14
La Verne, CA 91750-3451
Phone (909) 596-6349

Other identifiers 1

IdentifierTypeStateIssuer
00A730110MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090604000499 CA Part B Supplier - Clinic/Group Practice 8628128196 Receives reassigned benefits from 89 practitioners
7 other NPIs on this enrollment
Practice locations: Hemet, CA; Moreno Valley, CA; Norco, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; Yucaipa, CA; Colton, CA

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1295 Hamner Ave
Ste C
Norco, CA 92860
Phone (951) 272-6500

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1639314255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 FOOTHILL BLVD",
            "address_2": "#14",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503451",
            "telephone_number": "909-596-6349",
            "fax_number": "909-596-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044836",
            "telephone_number": "909-881-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA EMERGENCY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "BEARIE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-596-6349",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "A73011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A730110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.