Individual provider Active NPI

Clarissa Menard, D.O.

  • Family Medicine Physician
  • Baldwin Park, CA
National Provider Identifier
1700200763
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13156 Issued in CA
Practice address
1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806
Phone
(626) 851-1011
NPI assigned
Feb 11, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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 13156 CA Primary

Addresses

Primary practice location

1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806

Mailing address

675 S Arroyo Pkwy Ste 330
Pasadena, CA 91105-3264
Phone (626) 585-4123

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20150521001630 CA Practitioner - Family PracticePractitioner - General Practice 3476873050 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
College of Osteopathic Physicians and Surgeons of Los Angeles, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1011 Balwin Park Blvd
Baldwin Park, CA 91706-5806
Phone (626) 851-1011

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jan 15, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jan 15, 2019 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince May 30, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group Family Medicine CurrentSince May 30, 2015 Accepting new patients
Lakeside Medical Organization, a Medical Group Inc. Family Medicine CurrentSince Mar 21, 2015 Accepting new patients

Locations

1011 Baldwin Park Blvd
Baldwin Park, CA 91706
Phone (626) 851-1011

191 S Buena Vista St
Ste 200
Burbank, CA 91505
Phone (818) 887-2671

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

8510 Balboa Blvd
Ste 150
Northridge, CA 91325
Phone (818) 637-2000

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

675 S Arroyo Pkwy
Ste 330
Pasadena, CA 91105
Phone (626) 395-5268

601 Torrance Blvd
#1182
Redondo Beach, CA 90277

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

1500 W West Covina Pkwy
West Covina, CA 91790
Phone (626) 430-9991

Interoperability endpoints

  • Direct secure messaging: clarissa.menard.p1@direct.lakeside.nextgenshare.com

Organizations & group practices 5

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 1

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": "1392076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1700200763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 S ARROYO PKWY STE 330",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053264",
            "telephone_number": "626-585-4123",
            "fax_number": "626-795-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BALDWIN PARK BLVD",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917065806",
            "telephone_number": "626-851-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENARD",
        "first_name": "CLARISSA",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-11",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "13156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "c-cda",
            "address_1": "1011 Baldwin Park Blvd",
            "city": "Baldwin Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917065806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baldwin Park, CA

Sources for this page

Verify at the official NPI Registry.