NPIMap

Individual provider Active NPI

Walter Clyde Harris, PA-C, D.C.

  • Physician Assistant
  • Anaheim, CA
National Provider Identifier
1992945430
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15860 Issued in CA
Practice address
710 N Euclid St
Suite 201
Anaheim, CA 92801-4115
Phone
(714) 991-5002
Fax
(714) 517-2139
NPI assigned
Feb 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA15860 CA Primary

Addresses

Primary practice location

710 N Euclid St
Suite 201
Anaheim, CA 92801-4115

Mailing address

710 N Euclid St
Suite 201
Anaheim, CA 92801-4115
Phone (714) 991-5002

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)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA15860CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Anaheim Global Medical Center, Inc Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Elite Integrative Medical Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992945430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N EUCLID ST",
            "address_2": "SUITE 201",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928014115",
            "telephone_number": "714-991-5002",
            "fax_number": "714-517-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N EUCLID ST",
            "address_2": "SUITE 201",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928014115",
            "telephone_number": "714-991-5002",
            "fax_number": "714-517-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "WALTER",
        "middle_name": "CLYDE",
        "credential": "PA-C, D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.