BEAVER MEDICAL GROUP, LP
NPI 1619914959
Internal Medicine in Banning, CA

Q: What is Beaver Medical Group, LP's NPI number?

The NPI number for Beaver Medical Group, LP is 1619914959. It was assigned to this organization in the NPPES registry on June 2, 2006. The provider is doing business as Optum Banner Specialty Care.

Q: What is Beaver Medical Group, LP's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since June 02, 2006CLIA 05D0697649 · Waiver

6109 W RAMSEY ST, BANNING, CA 92220(951) 845-0313(909) 796-4158 Get Directions Write a Review

NPPES record last updated: February 19, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Beaver Medical Group, Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEAVER MEDICAL GROUP, LP (NPI 1619914959), doing business as Optum Banner Specialty Care, is a healthcare organization registered as an internal medicine in Banning, California and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through November 12, 2027 and lists Charles T Chen, Senior Medical Director, as its authorized official.

NPPES Registry Identity

NPI1619914959

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameBEAVER MEDICAL GROUP, LP

Location Address6109 W RAMSEY STBanning, CA 92220-3051

Mailing AddressPo Box 10069San Bernardino, CA 92423-0069 · (909) 335-4188

Phone(951) 845-0313

Fax(909) 796-4158

Organization SubpartYes

Authorized OfficialCharles T ChenSenior Medical Director · (909) 793-3311

Enumeration DateJune 2, 2006

Last NPPES UpdateFebruary 19, 2020

✔ NPI 1619914959 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 12

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedOptometristTaxonomy 152W00000X

Also ListedEmergency MedicineTaxonomy 207P00000X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X

Also ListedInternal Medicine · Medical OncologyTaxonomy 207RX0202X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOphthalmologyTaxonomy 207W00000X

Also ListedPediatricsTaxonomy 208000000X

Also ListedSurgeryTaxonomy 208600000X

Also ListedUrologyTaxonomy 208800000X

6109 W RAMSEY ST, Banning, CA 92220

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Other Names 1

Doing Business AsOptum Banner Specialty Care

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0697649

Beaver Medical Group PC San Bernardino · San Bernardino, CA

Active · expires Nov 12, 2027

CLIA Number05D0697649

Laboratory TypePhysician Office

Certificate Effective DateNovember 13, 2025

Certificate Expiration DateNovember 12, 2027

Laboratory DirectorDonna R. Thompson

Laboratory Phone(909) 786-0844

Laboratory LocationBeaver Medical Group PC San Bernardino1700 N Waterman Ave, San Bernardino, CA 92404

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 15

Medicare supplier enrollment and the product categories Beaver Medical Group LP carries, from the Medicare DMEPOS supplier directory.

Beaver Medical Group LP

DMEPOS supplier · Banning, CAOperated by Beaver Medical Group P C

✔

Accepts Medicare assignment

Beaver Medical Group LP agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20669915

Medicare Participant SinceAugust 17, 1994

Supplier Location6109 W Ramsey StBanning, CA 92220

Phone(951) 845-0313

Supplier Specialties

Optometrist Optician

Medicare Product Categories

Contracture Treatment Devices: Dynamic Splint

Dynamic splinting devices for the knee, elbow, wrist, finger, or toe

Negative Pressure Wound Therapy Pumps/Supplies

Wound care sets, Pumps, Canisters

Traction Equipment

Traction tables, Traction machines, Inversion tables

Canes and/or Crutches

Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches

Orthoses: Custom Fabricated

Custom met pads, Custom heel pads, Custom heel spur pads

Orthoses: Prefabricated (Non-Custom Fabricated)

Met pads, Heel pads, Heel spur pads

Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JAMES A MATHEY P.A.-C.

Physician Assistant