Andrea C Beavers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06332 Issued in TX

Practice address

6181 Bonnie View Rd Ste 160
Dallas, TX 75241-5149

Phone

(214) 374-0827

Fax

(214) 374-0927

NPI assigned

Jul 21, 2009

Last updated

Jan 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Wellmed Medical Group, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1437156486
  Medicare reassignment NPD
• Star Treatment Healthcare Services and Med Spa

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1407596794
  NPD Authorized official
• Wellmed Medical Group, P.a.

  dba WellMed Doctor's Hospital Senior Clinic

  • Family Medicine Physician
  • Corpus Christi, TX
  • NPI 1740588243
  NPD
• Physicians and Allied Health Professionals Group, PA

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1528011814
  NPD (past)

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1033349303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6181 BONNIE VIEW RD STE 160",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752415149",
            "telephone_number": "214-374-0827",
            "fax_number": "214-374-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6181 BONNIE VIEW RD STE 160",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752415149",
            "telephone_number": "214-374-0827",
            "fax_number": "214-374-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVERS",
        "first_name": "ANDREA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-21",
        "last_updated": "2024-01-17",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205082501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205082502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205082503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Celynne Joelle Beaudoin
• Londyn Christopher Beaudoin
• Rebecca Beaupre
• Beauty Bar Aesthetics and Wellness
• Beauty Bar by Terri
• Bruce Beavers, M.D.
• Carlos H Becerra, M.D.
• Hector Castillo Becerra, APRN
• Juan Ruiz Becerra
• Mary L. Becerril, PNP

• Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.