Beachman Psychiatry & Addiction Medical Clinic, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BEACHMAN PSYCHIATRY & ADDICTION MEDICAL CLINIC, INC.

Practice address

6969 Boulder Creek Dr
Eastvale, CA 92880-3680

Phone

(517) 505-5831

NPI assigned

May 26, 2025

Organization subpart

No

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

Authorized official

Name

Robert Jason, DONPI 1700260015

Title

Owner

Phone

(517) 505-5831

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Bertha M Ilongo, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Eureka, CA
  • NPI 1851659171

  CA

  Medicare reassignment NPD
• Robert A Jason, DO

  • Family Medicine Physician
  • Crescent City, CA
  • NPI 1700260015
  NPD Authorized official

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

{
    "created_epoch": "1748217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748217600000",
    "number": "1891588596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 WILSHIRE BLVD STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6969 BOULDER CREEK DR",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "928803680",
            "telephone_number": "517-505-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHMAN PSYCHIATRY & ADDICTION MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-26",
        "last_updated": "2025-05-26",
        "certification_date": "2025-05-26",
        "status": "A",
        "authorized_official_last_name": "JASON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-505-5831",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Eastvale, CA
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2025; 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.