Beachside Medical Group LLC

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

Legal business name

BEACHSIDE MEDICAL GROUP LLC

Practice address

123 Baptist Way
Pensacola, FL 32503-2254

Phone

(850) 473-0100

Fax

(850) 473-0500

NPI assigned

Mar 27, 2025

Last updated

Aug 15, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jaclyn H. Havinga, MDNPI 1730568379

Title

President

Phone

(850) 473-0100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Beachside Medical Group LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Beachside Medical Group LLC

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1568250512
  NPD tax ID
• Beachside Medical Group LLC

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1740078799
  NPD tax ID

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Beachside Medical Group LLC

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1568250512
  NPPES parent name
• Beachside Medical Group LLC

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1740078799
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jaclyn Havinga, MD

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1730568379
  Medicare reassignment NPD Authorized official
• Ramak R. Amjad, MD

  • Neonatal-Perinatal Medicine Physician
  • Pensacola, FL
  • NPI 1184604357
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1144022146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 GRANDE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048965",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 BAPTIST WAY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032254",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8383 N Davis Hwy",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325146039",
            "country_code": "US",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5151 N 9th Ave",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325048721",
            "country_code": "US",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACHSIDE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-27",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "HAVINGA",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-473-0100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bobby Ray Beal III, CRNA
• Chelsea P Beal

• Neonatal-Perinatal Medicine Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Neonatal-Perinatal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.