PACIFIC COAST PODIATRY PC
NPI 1285080978
Preferred Provider Organization in San Bernardino, CA
About Pacific Coast Podiatry Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PACIFIC COAST PODIATRY PC (NPI 1285080978) is a healthcare organization registered as a preferred provider organization in San Bernardino, California and active in the NPI registry since May 2016. The organization maintains a secondary practice location in San Clemente and lists Clayton Gary Johnsen, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pacific Coast Podiatry Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Pacific Coast Podiatry PC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
San Bernardino, CA 92404
San Bernardino, CA 92404
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Pacific Coast Podiatry PC's NPI number?
The NPI number for Pacific Coast Podiatry PC is 1285080978. It was assigned to this organization in the NPPES registry on May 11, 2016.
Where is Pacific Coast Podiatry PC located?
Pacific Coast Podiatry PC is located at 1762 N Waterman Ave, San Bernardino, CA 92404. The listed phone number is (909) 886-3668.
What is Pacific Coast Podiatry PC's specialty?
The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.
Is Pacific Coast Podiatry PC enrolled in Medicare?
Yes. Pacific Coast Podiatry PC is registered in the Medicare PECOS enrollment system.
When is Pacific Coast Podiatry PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (California, Physician - Podiatry) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Pacific Coast Podiatry PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Podiatry, reassign their Medicare billing to Pacific Coast Podiatry PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Pacific Coast Podiatry PC was last updated on June 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Pacific Coast Podiatry Pc · NPI 1285080978
Preferred Provider Organization organization in San Bernardino, California. Organization record, active in the CMS NPPES registry since May 11, 2016.
## Identity
- **NPI:** 1285080978 (Entity type: Organization)
- **Enumerated:** May 11, 2016
- **Primary specialty:** Preferred Provider Organization · taxonomy 305R00000X
- **Organization subpart:** No
- **Authorized official:** Clayton Johnsen, OWNER
## Practice location
- **Address:** 1762 N WATERMAN AVE, San Bernardino, CA 92404-5130
- **Phone:** (909) 886-3668 · **Fax:** (909) 886-5542
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (DME, California, Physician - Podiatry) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 5 clinicians (Podiatry) reassign Medicare billing to this organization (form CMS-855R); 3 practice at this address and 4 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 20, 2022
- **Other identifiers:** Other 1285080978
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Source: [NPI Profile](https://npiprofile.com/npi/1285080978) · Data from the CMS NPPES public registry.