Active NPI
Beverley Ann Elliott, M.D.
- Pediatrics Physician
- Roswell, NM
National Provider Identifier
1376595405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 94-237
- Practice address
- 813 N Washington Ave
Roswell, NM 88201-3941 - Phone
- (575) 622-2606
- Fax
- (575) 622-6645
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 94-237 | NM | Primary |
Addresses
Primary practice location
813 N Washington Ave
Roswell, NM 88201-3941
Mailing address
813 N Washington Ave
Roswell, NM 88201-3941
Phone (575) 622-2606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15613 | Medicaid | NM |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94-237 | NM | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307318400000",
"number": "1376595405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 N WASHINGTON AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882013941",
"telephone_number": "575-622-2606",
"fax_number": "575-622-6645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 N WASHINGTON AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882013941",
"telephone_number": "575-622-2606",
"fax_number": "575-622-6645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "BEVERLEY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-17",
"last_updated": "2011-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "94-237",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15613",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.