Lara Jennifer Beverly, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA05919 Issued in TX

Practice address

1339 S Broadway St
Sulphur Springs, TX 75482-4895

Phone

(903) 951-1001

NPI assigned

Oct 14, 2008

Last updated

Mar 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lbeverly70764@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1316199003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 S BROADWAY ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754824895",
            "telephone_number": "903-951-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1136 E Grande Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757033982",
            "country_code": "US",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEVERLY",
        "first_name": "LARA",
        "middle_name": "JENNIFER",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-14",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8Y9005",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210066104",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210066106",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Max Baxter II
• Talon Thomas Bell, DC
• Bennett J. Vaculik, D.D.S.,P.C.
• Better by the Hour Counseling, PLLC
• Steven Thomas Beuke, APRN, FNP-C
• Big Country Rehabilitation Inc (Steps 2 Strides of Sulphur Springs)
• Rosie Blackstock, COTA
• Blue Ribbon 02 Testing LLC
• Lauren Tye Boatman, LPC
• Robin Boshears, D.C.

• Physician Assistant in Sulphur Springs, TX
• Providers in Sulphur Springs, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.