NPIMap

Organization Active NPI

Beacon Integrated Healthcare

  • Family Nurse Practitioner
  • De Kalb, TX
National Provider Identifier
1164176749
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
BEACON INTEGRATED HEALTHCARE
Practice address
118 Wood St Ofc 1
De Kalb, TX 75559-2112
Phone
(903) 417-5377
NPI assigned
Feb 11, 2022
Organization subpart
Yes
Parent organization
PATIENT ACCESS FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Mr. Antonio D. Ingram, FNP-BCNPI 1144585761
Title
Ceo
Phone
(903) 417-5377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

118 Wood St Ofc 1
De Kalb, TX 75559-2112

Mailing address

PO Box 369
De Kalb, TX 75559-0369
Phone (903) 417-5377

National Provider Directory

National Provider Directory
Part of
Patient Access Foundation

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1644537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1164176749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755590369",
            "telephone_number": "903-417-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 WOOD ST OFC 1",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755592112",
            "telephone_number": "903-417-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON INTEGRATED HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATIENT ACCESS FOUNDATION",
        "enumeration_date": "2022-02-11",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-417-5377",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Kalb, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.