Beaver Medical Group P C

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BEAVER MEDICAL GROUP P C

Practice address

1690 Barton Road
Redlands, CA 92373-4231

Phone

(909) 793-3311

Fax

(909) 335-4111

NPI assigned

Nov 15, 2012

Last updated

Apr 2, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

BEAVER MEDICAL GROUP P CAs reported in NPPES

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

Authorized official

Name

Emily Castillo

Title

Associate Director

Phone

(702) 480-2550

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Beaver Medical Group P C

  • Internal Medicine Physician
  • Colton, CA
  • NPI 1144265919

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  dba Beaver Advantage Health Center

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1275570830

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  • Internal Medicine Physician
  • Highland, CA
  • NPI 1598706293

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  • Durable Medical Equipment & Medical Supplies
  • Beaumont, CA
  • NPI 1609110667

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  dba Optum Banner Specialty Care

  • Internal Medicine Physician
  • Banning, CA
  • NPI 1619914959

  0547164295

  Same PAC ID
• Beaver Medical Group P C

  dba Optum

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319

  0547164295

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Part of

Redlands Ucc

Locations

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1790029759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 BARTON ROAD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734231",
            "telephone_number": "909-793-3311",
            "fax_number": "909-335-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER MEDICAL GROUP P C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAVER MEDICAL GROUP P C",
        "enumeration_date": "2012-11-15",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beaver Medical Group P C
• Beaver Medical Group P C (Beaver Advantage Health Center)
• Beaver Medical Group P C
• Beaver Medical Group P C (Beaver Medical Group - Primary Care North)
• Beaver Medical Group P C (Optum)
• Beaver Medical Group, L.P.
• Beaver Medical Group, LP
• Beaver Medical Group, LP
• Steven Beck, M.D.
• Melisa Raquel Beckley, D.D.S.

• Durable Medical Equipment & Medical Supplies in Redlands, CA
• Providers in Redlands, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.