Active NPI
Nicholas Robert Beatty, PA
- Medical Physician Assistant
- Grand Terrace, CA
National Provider Identifier
1295927747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA14337
- Practice address
- 22182 Barton Rd
Grand Terrace, CA 92313-5033 - Phone
- (909) 422-0422
- NPI assigned
- Aug 17, 2007
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA14337 | CA | Primary |
Addresses
Primary practice location
22182 Barton Rd
Grand Terrace, CA 92313-5033
Mailing address
22182 Barton Rd
Grand Terrace, CA 92313-5033
Phone (909) 422-0422
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA14337 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187308800000",
"number": "1295927747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22182 BARTON RD",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135033",
"telephone_number": "909-422-0422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22182 BARTON RD",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135033",
"telephone_number": "909-422-0422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATTY",
"first_name": "NICHOLAS",
"middle_name": "ROBERT",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-17",
"last_updated": "2007-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA14337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Terrace, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.