Individual provider Active NPI

Clint Troy Pearson, MD

  • Family Medicine Physician
  • Crescent City, CA
National Provider Identifier
1659464113
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A63491 Issued in CA
Practice address
550 E Washington Blvd
Crescent City, CA 95531-8342
Phone
(707) 465-6925
Fax
(707) 465-6070
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A63491 CA Primary

Addresses

Primary practice location

550 E Washington Blvd
Crescent City, CA 95531-8342

Mailing address

670 Ninth Street
Suite 203
Arcata, CA 95521
Phone (707) 826-8633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050713001115 CA Practitioner - Family Practice 6406882174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Open Door Community Health CentersGroup PAC ID 9436067485, 113 clinicians

Practice addresses (Care Compare)

2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624

550 E Washington Blvd
Crescent City, CA 95531-8160
Phone (707) 465-6925

Hospital & facility affiliations

  • Sutter Coast Hospital Hospital, Crescent City, CA, CCN 050417

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63491CAMDMarriage & Family Therapist
A63491CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers CurrentSince May 31, 2005 Accepting new patients
Open Door Community Health Centers CurrentSince May 31, 2005 Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636

550 E Washington Blvd
Ste 100
Crescent City, CA 95531
Phone (707) 465-6925

670 9th St
Ste 203
McKinleyville, CA 95521

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1659464113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 NINTH STREET",
            "address_2": "SUITE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "95521",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318342",
            "telephone_number": "707-465-6925",
            "fax_number": "707-465-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "CLINT",
        "middle_name": "TROY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A63491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, CA

Sources for this page

Verify at the official NPI Registry.