Beau Prey

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

33180 Issued in NE

Practice address

9040 Fitzsimmons Dr
Joint Base Lewis McChord, WA 98431-1000

Phone

(253) 968-0236

NPI assigned

Feb 5, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1144785049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 W LOVELL ST APT 210B",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490074524",
            "telephone_number": "248-880-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 FITZSIMMONS DR",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000",
            "telephone_number": "253-968-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREY",
        "first_name": "BEAU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-05",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NE",
            "license": "33180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Minh Phung, DMD
• Jose Davod Picart III
• Kellie Lynn Piles
• John Anthony Poglodzinski
• Lauren Powers, ATC, SCAT
• Boonkit Purt, MD
• Ruth A. Racine, R.N., F.N.P.
• Justin Rajala
• Aimee Nicole Rambie
• Sabrina Meier Ramme, RD

• Surgery Physician in Joint Base Lewis McChord, WA
• Providers in Joint Base Lewis McChord, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.