Roger W Beville, MD
Individual provider Active NPI Family Medicine Physician · Glennville, GA
NPI 1154435550 · NPPES record last updated Jan 26, 2017
Key facts
- NPI
- 1154435550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 028377 (GA)
- Practice address
- 1000 B. North Veterans Boulevard
Glennville, GA 30427 - Phone
- (912) 654-4599
- Fax
- (912) 644-5260
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070219000614 | GA | Practitioner - Family Practice | 0143322370 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 028377 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SJC Medical Group Inc | Family Medicine | Current |
Accepting new patients |
Locations
10 Doctors St
Metter, GA 30439
Phone (912) 685-5715
400 Cedar St
Metter, GA 30439
Phone (912) 685-1726
11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452
Interoperability endpoints
- roger.beville@healthiealerts.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 028377 | GA | Yes |
Addresses
Primary practice location
1000 B. North Veterans Boulevard
Glennville, GA 30427
Mailing address
460 Mall Blvd
Suite B
Savannah, GA 31406-4801
Phone (912) 644-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000641946B | Medicaid | GA | |
| 08CBCPS | Other | GA | MEDICARE # CAHABA |
| 336806 | Other | GA | WELLCARE |
| 000641946C | Medicaid | GA |
Other providers in Glennville, GA
- Lisa Dasher Anderson
- At Home ABA, LLC
- Morgan Lynn Bland
- Corri Nicole Brewer
- Jana Lamb Bunch
- Sharmeki Burton
- C.R. of Glenvue, LLC
All providers in Glennville, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.