Individual provider Active NPI

Jason Beaver, PA-C

  • Physician Assistant
  • Tallahassee, FL
National Provider Identifier
1124426457
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9108737 Issued in FL
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

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
2423OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority PastSince Dec 31, 2008 Accepting new patients
Martin Memorial Physician Corporation Inc PastSince Apr 1, 2004 Accepting new patients
Tallahassee Orthopedic Clinic III PL Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: 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.

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.

Verify at the official NPI Registry.