Active NPI
Andre Eagles
- Behavior Analyst
- Las Vegas, NV
National Provider Identifier
1295202513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 6330 W Azure Dr
Las Vegas, NV 89130-7287 - Phone
- (702) 800-1932
- NPI assigned
- Oct 24, 2018
- Last updated
- Oct 24, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
6330 W Azure Dr
Las Vegas, NV 89130-7287
Mailing address
6330 W Azure Dr
Las Vegas, NV 89130-7287
Phone (170) 250-2330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1501017565 | Other | NV | DRIVER LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifestyle Remedies Wellness Center LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Las Vegas, NV
- NPI 1932676251
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1295202513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6330 W AZURE DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891307287",
"telephone_number": "170-250-2330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6330 W AZURE DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891307287",
"telephone_number": "702-800-1932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EAGLES",
"first_name": "ANDRE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "1501017565",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.