Individual provider Active NPI

Michael Beauchaine

  • Physician Assistant
  • West Linn, OR
National Provider Identifier
1255672465
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4229-23 Issued in WI
Practice address
2020 8TH Ave
Suite 200
West Linn, OR 97068
Phone
(503) 512-1212
NPI assigned
Mar 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA174762 OR
Physician Assistant 363A00000X 4229-23 WI Primary

Addresses

Primary practice location

2020 8TH Ave
Suite 200
West Linn, OR 97068

Mailing address

PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171121001018 WI Practitioner - Physician Assistant 4183932742 Reassigns benefits to 1 organization
I20210121002074 MI Practitioner - Physician Assistant 4183932742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Dermatology Group LTDGroup PAC ID 9537312665, 23 clinicians

Practice addresses (Care Compare)

1606 S Stephenson Ave
Iron Mountain, MI 49801-3636
Phone (920) 965-0345

2360 Duck Creek Pkwy
Green Bay, WI 54303-3300
Phone (920) 965-0345

2601 1St Ave N
Escanaba, MI 49829-1448
Phone (920) 965-0345

3059 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 965-0345

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4229-23WIMDPhysician Assistant
PA174762ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New Dermatology Group LTD Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: michael.beauchaine.1@23194.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1255672465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE",
            "address_2": "SUITE 200",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "97068",
            "telephone_number": "503-512-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUCHAINE",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-13",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA174762",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "4229-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Linn, OR

Sources for this page

Verify at the official NPI Registry.