Individual provider Active NPI

Chadwick Dale Beaver, ACNP

  • Acute Care Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1194054239
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP118578 Issued in TX
Practice address
3601 21St St
Lubbock, TX 79410-1229
Phone
(806) 791-0399
Fax
(806) 791-0373
NPI assigned
Dec 21, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP118578 TX Primary

Addresses

Primary practice location

3601 21St St
Lubbock, TX 79410-1229

Mailing address

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

Other identifiers 3

IdentifierTypeStateIssuer
8295NSOtherTXBCBS
308679503MedicaidTX
335111YKT8OtherTXMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101103000131 TX Practitioner - Nurse Practitioner 9436343530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

3601 21St St
Lubbock, TX 79410-1229
Phone (806) 791-0399

7601 Quaker Ave
Lubbock, TX 79424-3360
Phone (806) 725-9444

9812 Slide Rd
Lubbock, TX 79424-5781
Phone (806) 725-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP118578TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group CurrentSince Nov 1, 2015 Accepting new patients
Covenant Medical Group CurrentSince Nov 1, 2015 Accepting new patients

Locations

3420 22nd Pl
Lubbock, TX 79410
Phone (806) 725-1800

4408 6th St
Lubbock, TX 79416
Phone (806) 791-0399

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

3601 21st St
Lubbock, TX 79410
Phone (806) 791-0399

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1194054239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 21ST ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101229",
            "telephone_number": "806-791-0399",
            "fax_number": "806-791-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "CHADWICK",
        "middle_name": "DALE",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-21",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP118578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8295NS",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "308679503",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "335111YKT8",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.