NPIMap

Individual provider Active NPI

Blake Richard Beazer, MD

  • Family Medicine Physician
  • Tooele, UT
National Provider Identifier
1073510012
Registry record updated Mar 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5248080-1205 Issued in UT
Practice address
2356 N 400 E
Ste 201
Tooele, UT 84074
Phone
(435) 882-2350
Fax
(435) 882-2039
NPI assigned
Jul 6, 2005
Last updated
Mar 21, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5248080-1205 UT Primary

Addresses

Primary practice location

2356 N 400 E
Ste 201
Tooele, UT 84074

Mailing address

2356 N 400 E
Ste 201
Tooele, UT 84074
Phone (435) 882-2350

Other identifiers 1

IdentifierTypeStateIssuer
D4916MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041217000245 UT Practitioner - Family Practice 5395702963 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Blake R Beazer MD IncGroup PAC ID 1850323619, 2 clinicians

Practice addresses (Care Compare)

2356 N 400E
201 Mountain West Family Practice
Tooele, UT 84074-8112
Phone (435) 882-2350

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5248080-1205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blake R. Beazer, M.D., Inc Family Medicine CurrentSince Jan 10, 2003 Accepting new patients
Washington Hospital Past Accepting new patients
Alpine Health and Rehabilitation Center LC PastSince Jul 1, 2017 Accepting new patients

Locations

2356 N 400 E
Ste 201
Tooele, UT 84074
Phone (435) 882-2350

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395360000000",
    "number": "1073510012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2356 N 400 E",
            "address_2": "STE 201",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "435-882-2350",
            "fax_number": "435-882-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 N 400 E",
            "address_2": "STE 201",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "84074",
            "telephone_number": "435-882-2350",
            "fax_number": "435-882-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAZER",
        "first_name": "BLAKE",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2014-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "5248080-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D4916",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tooele, UT

Sources for this page

Verify at the official NPI Registry.