Active NPI
Jason Beaver, PA-C
- Physician Assistant
- Tallahassee, FL
National Provider Identifier
1124426457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9108737
- Practice address
- 2605 Welaunee Blvd
Tallahassee, FL 32308-4697 - Phone
- (850) 877-8174
- Fax
- (844) 261-6839
- NPI assigned
- Dec 19, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2423 | OK | |
| Physician Assistant | 363A00000X | PA9108737 | FL | Primary |
Addresses
Primary practice location
2605 Welaunee Blvd
Tallahassee, FL 32308-4697
Mailing address
3334 Capital Medical Blvd Ste 400
Tallahassee, FL 32308-4470
Phone (850) 877-8174
Other practice location 1
3334 Capital Medical Blvd Ste 400
Tallahassee, FL 32308-4470
Phone (508) 778-1748
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2423 | OK | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| Martin Memorial Physician Corporation Inc | Past | Accepting new patients | |
| Tallahassee Orthopedic Clinic III PL | Past | Accepting new patients |
Interoperability endpoints
- jason.beaver.1@18802.direct.athenahealth.com
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Stuart, FL
- NPI 1578505228
-
- Medical Specialty Clinic/Center
- Tallahassee, FL
- NPI 1194778050
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678924800000",
"number": "1124426457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3334 CAPITAL MEDICAL BLVD STE 400",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084470",
"telephone_number": "850-877-8174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2605 WELAUNEE BLVD",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323084697",
"telephone_number": "850-877-8174",
"fax_number": "844-261-6839"
}
],
"practiceLocations": [
{
"address_1": "3334 Capital Medical Blvd Ste 400",
"address_purpose": "LOCATION",
"city": "Tallahassee",
"state": "FL",
"postal_code": "323084470",
"country_code": "US",
"telephone_number": "508-778-1748",
"fax_number": "442-616-8398",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BEAVER",
"first_name": "JASON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-19",
"last_updated": "2023-03-16",
"certification_date": "2023-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "2423",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9108737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.