Bryan D Beaver, M.D.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

01082967A Issued in IN

Practice address

2304 Kossuth St
Lafayette, IN 47904-3240

Phone

(765) 446-9600

Fax

(765) 446-1100

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lafayette Neonatal Associates PC

  • Neonatal-Perinatal Medicine Physician
  • Lafayette, IN
  • NPI 1669636064
  NPD (past)
• Porter Neonatal Group

  • Neonatal-Perinatal Medicine Physician
  • Valparaiso, IN
  • NPI 1912296682
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1396833109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 KOSSUTH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043240",
            "telephone_number": "765-446-9600",
            "fax_number": "765-446-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 KOSSUTH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043240",
            "telephone_number": "765-446-9600",
            "fax_number": "765-446-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "165 Marata St.",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Tamuning",
            "state": "yes",
            "postal_code": "96913",
            "country_code": "UM",
            "telephone_number": "671-969-8276",
            "country_name": "United States Minor Outlying Islands",
            "address_type": "FGN"
        }
    ],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "BRYAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01082967A",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "GU",
            "license": "M1812",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300031240",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208338905",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael J Beardmore, MD
• Jackie N. Beas, PT
• Audrey Emerald Rose Beason, BA
• Patricia Ann Beaty, PT
• Aerica Beaver
• Ariel Beck, RB T
• Stephen D Beck, M.D.
• Jenna N Becker, NP
• Lindsey Marie Becker, PMHNP
• Lisa Marie Becker

• Neonatal-Perinatal Medicine Physician in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Neonatal-Perinatal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.