Active NPI
Michael A Beelman, ATC, CSCS
- Other Technician
- Jacksonville, FL
National Provider Identifier
1104963693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- AL 2102
- Practice address
- 1325 San Marco Blvd
Jacksonville, FL 33307 - Phone
- (904) 391-6805
- NPI assigned
- Jan 31, 2007
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | AL 2102 | FL | Primary |
Addresses
Primary practice location
1325 San Marco Blvd
Jacksonville, FL 33307
Mailing address
8146 Summerside Circle
Jacksonville, FL 32256
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 |
|---|---|---|---|
| AL 2102 | FL | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104963693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8146 SUMMERSIDE CIRCLE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 SAN MARCO BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "33307",
"telephone_number": "904-391-6805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEELMAN",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "ATC, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "FL",
"license": "AL 2102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.