NPIMap

Individual provider Active NPI

Clifford Carl Douglas, MD, PH.D.

  • Neurological Surgery Physician
  • Riverside, CA
National Provider Identifier
1932166485
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
G70288 Issued in CA
Practice address
4510 Brockton Ave Ste 175
Riverside, CA 92501-4020
Phone
(951) 786-5550
NPI assigned
Apr 27, 2006
Last updated
Apr 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X G70288 CA Primary

Addresses

Primary practice location

4510 Brockton Ave Ste 175
Riverside, CA 92501-4020

Mailing address

PO Box 743111
Atlanta, GA 30374-3111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116001251 CA Practitioner - Neurosurgery 3678537990 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Loma Linda University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Golden State Providers, a Medical CorporationGroup PAC ID 7012212475, 23 clinicians

Practice addresses (Care Compare)

4445 Magnolia Ave
Riverside, CA 92501-4135
Phone (951) 788-3000

4510 Brockton Ave
Suite 175
Riverside, CA 92501-4020
Phone (951) 786-5550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion105
Laminectomy or laminotomy (partial removal of spine bones)65
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jan 15, 2017 Accepting new patients
Faculty Physicians and Surgeons of Llusm Neurological Surgery Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Golden State Providers, a Medical Corporation CurrentSince Apr 15, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Primecare Medical Group Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Uhs Corona Inc Past Accepting new patients
Loma Linda University Children's Hospital Past Accepting new patients

Locations

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

11370 Anderson St
Ste 1800
Loma Linda, CA 92354
Phone (909) 558-2154

11370 Anderson St
Ste 2600
Loma Linda, CA 92354
Phone (909) 558-2890

11406 Loma Linda Dr
Ste 300
Loma Linda, CA 92354
Phone (909) 558-6277

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

4510 Brockton Ave
Ste 175
Riverside, CA 92501
Phone (951) 786-5100

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: cdouglas57968@direct.llu.edu
  • Direct secure messaging: clifford.douglas@hca3.eclinicaldirectplus.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1932166485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743111",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 BROCKTON AVE STE 175",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014020",
            "telephone_number": "951-786-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CLIFFORD",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "MD, PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G70288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.