Active NPI
Jeffrey Gary Beach, RDN
- Registered Dietitian
- Detroit, MI
National Provider Identifier
1053949701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86089803
- Practice address
- 13901 E Jefferson Ave
Detroit, MI 48215-2720 - Phone
- (313) 822-0900
- NPI assigned
- Mar 30, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86089803 | MI | Primary |
Addresses
Primary practice location
13901 E Jefferson Ave
Detroit, MI 48215-2720
Mailing address
13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone (313) 822-0900
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86089803 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585699200000",
"number": "1053949701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13901 E JEFFERSON AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482152720",
"telephone_number": "313-822-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13901 E JEFFERSON AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482152720",
"telephone_number": "313-822-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEACH",
"first_name": "JEFFREY",
"middle_name": "GARY",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-30",
"last_updated": "2020-04-01",
"certification_date": "2020-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "86089803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.