Bear Mountain Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BEAR MOUNTAIN FAMILY PRACTICE

Practice address

41945 Big Bear Blvd Ste 200
Big Bear Lake, CA 92315-2030

Phone

(909) 866-5868

Fax

(909) 866-5860

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Christopher H. Fagan, MD

Title

President

Phone

(909) 866-5868

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kellie Barbara Ann Ploense, FNP-C

  • Family Nurse Practitioner
  • Big Bear Lake, CA
  • NPI 1942669940
  NPD (past)
• Susan Ellis, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Roseburg, OR
  • NPI 1750706800
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1720107592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 6848, PMB 278",
            "address_2": "41933 BIG BEAR BLVD",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-866-5868",
            "fax_number": "909-866-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41945 BIG BEAR BLVD STE 200",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "923152030",
            "telephone_number": "909-866-5868",
            "fax_number": "909-866-5860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41933 Big Bear Blvd.",
            "address_2": "6848 PMB 278",
            "address_purpose": "LOCATION",
            "city": "Big Bear Lake",
            "state": "CA",
            "postal_code": "92315",
            "country_code": "US",
            "telephone_number": "909-866-5868",
            "fax_number": "909-866-5860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAR MOUNTAIN FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-866-5868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Atomic Shrink Psychology, Inc
• Renee Colleen Bacon
• Stephanie Elizabeth Bartel
• Be Fulfilled Therapy Solutions
• Brent Alan Beaird, MD
• Bear Mountain Medical Services, a Medical Corporation
• Bear Valley Community Health Care District
• Bear Valley Community Health Care District
• Bear Valley Community Health Care District
• Bear Valley Dental Care

• Family Medicine Physician in Big Bear Lake, CA
• Providers in Big Bear Lake, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.