NPIMap

Organization Active NPI

Landmark Anesthesia Medical Group Prime

  • Anesthesiology Physician
  • Victorville, CA
National Provider Identifier
1801430467
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
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
Last updated
Dec 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Authorized official

Name
Dr. Hanh Nguyen-ClarkNPI 1649222308
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)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 IDStateProvider typePAC IDDetails
O20200217000203 CA Part B Supplier - Clinic/Group Practice 5890122683 Receives reassigned benefits from 34 practitioners
Practice locations: Victorville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

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.

Verify at the official NPI Registry.