Active NPI
Landmark Anesthesia Medical Group Prime
- Anesthesiology Physician
- Victorville, CA
National Provider Identifier
1801430467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- Legal business name
- LANDMARK ANESTHESIA MEDICAL GROUP PRIME
- Practice address
- 16850 Bear Valley Rd
Victorville, CA 92395-5794 - Phone
- (760) 241-8000
- NPI assigned
- Nov 6, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Hanh Nguyen-Clark
- Title
- President
- Phone
- (714) 503-0195
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | Primary |
Addresses
Primary practice location
16850 Bear Valley Rd
Victorville, CA 92395-5794
Mailing address
2271 W Malvern Ave Unit 139
Fullerton, CA 92833-2106
Phone (714) 503-0195
Other practice location 1
5451 Walnut Ave
Chino, CA 91710-2609
Phone (909) 464-8600
Other practice location 2
1350 W Covina Blvd
San Dimas, CA 91773-3245
Phone (909) 599-6811
Other practice location 3
4929 Van Nuys Blvd
Sherman Oaks, CA 91403-1702
Phone (818) 981-7111
Other practice location 4
16237 Ventura Blvd
Encino, CA 91436-2201
Phone (818) 995-5000
Other practice location 5
5000 San Bernardino St
Montclair, CA 91763-2326
Phone (909) 625-5411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200217000203 | CA | Part B Supplier - Clinic/Group Practice | 5890122683 |
Receives reassigned benefits from 34 practitioners Practice locations: Victorville, CA |
National Provider Directory
National Provider DirectoryLocations
5451 Walnut Ave
Chino, CA 91710
Phone (909) 464-8600
Practitioners & affiliated clinicians
Practitioners 34
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572998400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1669939200000",
"number": "1801430467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2271 W MALVERN AVE UNIT 139",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928332106",
"telephone_number": "714-503-0195",
"fax_number": "714-676-8603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16850 BEAR VALLEY RD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923955794",
"telephone_number": "760-241-8000"
}
],
"practiceLocations": [
{
"address_1": "5451 Walnut Ave",
"address_purpose": "LOCATION",
"city": "Chino",
"state": "CA",
"postal_code": "917102609",
"country_code": "US",
"telephone_number": "909-464-8600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1350 W Covina Blvd",
"address_purpose": "LOCATION",
"city": "San Dimas",
"state": "CA",
"postal_code": "917733245",
"country_code": "US",
"telephone_number": "909-599-6811",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4929 Van Nuys Blvd",
"address_purpose": "LOCATION",
"city": "Sherman Oaks",
"state": "CA",
"postal_code": "914031702",
"country_code": "US",
"telephone_number": "818-981-7111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16237 Ventura Blvd",
"address_purpose": "LOCATION",
"city": "Encino",
"state": "CA",
"postal_code": "914362201",
"country_code": "US",
"telephone_number": "818-995-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5000 San Bernardino St",
"address_purpose": "LOCATION",
"city": "Montclair",
"state": "CA",
"postal_code": "917632326",
"country_code": "US",
"telephone_number": "909-625-5411",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "LANDMARK ANESTHESIA MEDICAL GROUP PRIME",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-06",
"last_updated": "2022-12-02",
"certification_date": "2022-12-02",
"status": "A",
"authorized_official_last_name": "NGUYEN-CLARK",
"authorized_official_first_name": "HANH",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "714-503-0195",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Anesthesiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.