Beacon Primary Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BEACON PRIMARY CARE LLC

Practice address

17819 Tidewater Bay LN
Lutz, FL 33549-5419

Phone

(813) 447-9249

NPI assigned

Dec 29, 2021

Last updated

Dec 29, 2021By 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

Tyler Penrod

Title

Biller

Phone

(832) 289-9225

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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.

• Sonia Maria Segui, ARNP

  • Family Nurse Practitioner
  • Tampa, FL
  • NPI 1780126052
  Medicare reassignment NPD

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

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640736000000",
    "number": "1184384349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17819 TIDEWATER BAY LN",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335495419",
            "telephone_number": "813-447-9249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17819 TIDEWATER BAY LN",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335495419",
            "telephone_number": "813-447-9249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-29",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "PENROD",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "832-289-9225"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baycare Medical Group Pediatric Walk-in Care LLC
• Lance Bayer, PT
• Brittany Bayliss, LCSW
• Sadaf Bazargan, MD
• BB Wellness (Foundation Chiropractic)
• Lea Clair Beal, LCSW
• Sara Christina Beal, APRN
• Roxanne Juliet Beaton, LMH
• Ashlee Beck
• Ronald Becker, CRNA

• Family Medicine Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.