Active NPI
Russell Clark
- General Acute Care Hospital
- Beaumont, CA
National Provider Identifier
1952554420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 515669CA
- Practice address
- 1412 Liatris Way
Beaumont, CA 92223-8468 - Phone
- (951) 769-1241
- NPI assigned
- Oct 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 515669CA | CA | Primary |
Addresses
Primary practice location
1412 Liatris Way
Beaumont, CA 92223-8468
Mailing address
1412 Liatris Way
Beaumont, CA 92223-8468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 515669CA | CA | MD | General Acute Care Hospital |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1952554420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1412 LIATRIS WAY",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922238468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 LIATRIS WAY",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922238468",
"telephone_number": "951-769-1241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RUSSELL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "CA",
"license": "515669CA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.