Andrew William Cleaver

Key facts

NPI

1720728199

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

60279027 (WA)

Practice address

10535 Hospital Way
Mather, CA 95655-4200

Phone

(916) 843-2752

NPI assigned

Mar 31, 2022

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• County of Sacramento Radiology Clinic/Center · Sacramento, CA · NPI 1508936030
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 6, 2023.

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1720728199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8517 OAK AVE UNIT B",
            "city": "ORANGEVALE",
            "state": "CA",
            "postal_code": "956622332",
            "telephone_number": "206-557-2769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10535 HOSPITAL WAY",
            "city": "MATHER",
            "state": "CA",
            "postal_code": "956554200",
            "telephone_number": "916-843-2752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1103 N B St Ste E",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958110326",
            "country_code": "US",
            "telephone_number": "916-378-8266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLEAVER",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-31",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "60279027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Mather, CA · Physical Therapy Assistant in California