Mark D Beale I, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

93-208 Issued in NM

Practice address

133 Wyatt Dr
Suite 9
Las Cruces, NM 88005-2962

Phone

(575) 680-2684

Fax

(575) 680-2655

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1164547709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 WYATT DR",
            "address_2": "SUITE 9",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052962",
            "telephone_number": "575-680-2684",
            "fax_number": "575-680-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 WYATT DR",
            "address_2": "SUITE 9",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880052962",
            "telephone_number": "575-680-2684",
            "fax_number": "575-680-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEALE",
        "first_name": "MARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "NM",
            "license": "93-208",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NM",
            "license": "93-208",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "93-208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164547709",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHIATRY/PAIN MANAGEMENT",
            "identifier": "1164547709",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kathryn Marie Becker, L.I.S.W.
• Jacquelyn Theresa Beckett
• Aaliyah Bedichandani

• Psychiatry Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Psychiatry Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.