Individual provider Active NPI

Beverlie Houser, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Fort Gratiot, MI
National Provider Identifier
1003204660
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
4704266184 Issued in MI
Practice address
4190 24TH Ave
Fort Gratiot, MI 48059-3882
Phone
(810) 989-7788
Fax
(810) 989-7799
NPI assigned
Jan 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 4704266184 MI Primary

Addresses

Primary practice location

4190 24TH Ave
Fort Gratiot, MI 48059-3882

Mailing address

4190 24TH Ave
Fort Gratiot, MI 48059-3882
Phone (810) 989-7788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150223001154 MI Practitioner - Nurse Practitioner 8921324617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Healthcare Network PCGroup PAC ID 3476456252, 30 clinicians

Practice addresses (Care Compare)

3350 Gratiot Blvd
Marysville, MI 48040-2121
Phone (810) 364-4000

4190 24TH Ave
Fort Gratiot, MI 48059-3882
Phone (810) 989-7788

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704266184MIMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Healthcare Network, PC Nurse Practitioner CurrentSince Jan 9, 2015 Accepting new patients

Locations

4190 24th Ave
Fort Gratiot, MI 48059
Phone (810) 216-4300

4190 24th Ave
Ste B
Fort Gratiot, MI 48059

3350 Gratiot Blvd
Marysville, MI 48040
Phone (810) 364-4000

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1003204660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7788",
            "fax_number": "810-989-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7788",
            "fax_number": "810-989-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSER",
        "first_name": "BEVERLIE",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704266184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gratiot, MI

Sources for this page

Verify at the official NPI Registry.