NPIMap

Individual provider Active NPI

Alec Beaulieu, PA-C

  • Physician Assistant
  • Canton, MA
National Provider Identifier
1376105049
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7132 Issued in MA
Practice address
45 Dan Rd
Canton, MA 02021-2852
Phone
(781) 867-2050
NPI assigned
Jul 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA7132 MA Primary
Physician Assistant 363A00000X 1525 NH

Addresses

Primary practice location

45 Dan Rd
Canton, MA 02021-2852

Mailing address

45 Dan Rd
Canton, MA 02021-2852
Phone (781) 867-2050

Other practice location 1

99 Chelmsford Rd Ste 8
North Billerica, MA 01862-1351
Phone (978) 244-0411

Other identifiers 1

IdentifierTypeStateIssuer
3119149MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191029001579 NH Practitioner - Physician Assistant 4981936713 Reassigns benefits to 2 organizations
I20230309002459 MA Practitioner - Physician Assistant 4981936713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Healthcare LLCGroup PAC ID 8224361191, 72 clinicians

Practice addresses (Care Compare)

12 Bluebird Rd
Wellesley, MA 02481-3503
Phone (774) 309-4129

22 Tuck Rd
Hampton, NH 03842-1225
Phone (781) 867-2050

319 E Dunstable Rd
Nashua, NH 03062-4207
Phone (603) 888-7878

8 Jennifer Dr
Merrimack, NH 03054-4411
Phone (603) 424-5919

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1525NHMDPhysical Therapy Assistant
PA7132MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Eldercare Physician Services LLC CurrentSince Aug 5, 2023 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Aug 5, 2023 Accepting new patients
Greater Hampstead Family Medicine, Inc. PastSince Jun 1, 2020 Accepting new patients
Arizona LS, LLC Past Accepting new patients

Locations

89 Morton St
Andover, MA 01810
Phone (978) 475-0944

Organizations & group practices 6

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 5

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": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1376105049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 DAN RD",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212852",
            "telephone_number": "781-867-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 DAN RD",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212852",
            "telephone_number": "781-867-2050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 Chelmsford Rd Ste 8",
            "address_purpose": "LOCATION",
            "city": "North Billerica",
            "state": "MA",
            "postal_code": "018621351",
            "country_code": "US",
            "telephone_number": "978-244-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAULIEU",
        "first_name": "ALEC",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7132",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3119149",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MA

Sources for this page

Verify at the official NPI Registry.