NPIMap

Organization Active NPI

Beacon Cancer Care PLLC

Doing business as Beacon Clinic

  • Multi-Specialty Clinic/Center
  • Coeur d'Alene, ID
National Provider Identifier
1407335367
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BEACON CANCER CARE PLLC
Doing business as
Beacon Clinic
Practice address
3815 N Schreiber Way Ste 101
Coeur D Alene, ID 83815-8362
Phone
(208) 755-2804
Fax
(208) 765-0277
NPI assigned
Aug 11, 2018
Last updated
Aug 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Dr. David Cadwell Bartels, DONPI 1245492768
Title
Owner
Phone
(208) 775-2804

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0000X
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X
Medical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RX0202X
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X
Multi-Specialty Clinic/Center 261QM1300X Primary
Oncology Clinic/Center 261QX0200X
Radiation Oncology Clinic/Center 261QX0203X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3815 N Schreiber Way Ste 101
Coeur D Alene, ID 83815-8362

Mailing address

3815 N Schreiber Way Ste 101
Coeur D Alene, ID 83815-8362
Phone (208) 755-2804

Other practice location 1

1641 E Polston Ave Ste 102
Post Falls, ID 83854-7852
Phone (208) 755-2804

Other practice location 2

229 S 7th St
St Maries, ID 83861-1803
Phone (208) 755-2804

Other names 2

  • Beacon Clinic Doing business as
  • Beacon Rheumatology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181004002759 ID Part B Supplier - Clinic/Group Practice 6901158773 Receives reassigned benefits from 17 practitioners
Practice locations: Boise, ID; Coeur D Alene, ID; Post Falls, ID; St Maries, ID

National Provider Directory

National Provider Directory

Locations

8950 W Emerald St
Ste 108
Boise, ID 83704
Phone (208) 672-8682

30544 Highway 200
Ste 302
Ponderay, ID 83852

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1533945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1407335367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 N SCHREIBER WAY STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158362",
            "telephone_number": "208-755-2804",
            "fax_number": "208-765-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 N SCHREIBER WAY STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158362",
            "telephone_number": "208-755-2804",
            "fax_number": "208-765-0277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1641 E Polston Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Post Falls",
            "state": "ID",
            "postal_code": "838547852",
            "country_code": "US",
            "telephone_number": "208-755-2804",
            "fax_number": "208-765-0277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "229 S 7th St",
            "address_purpose": "LOCATION",
            "city": "St Maries",
            "state": "ID",
            "postal_code": "838611803",
            "country_code": "US",
            "telephone_number": "208-755-2804",
            "fax_number": "208-765-0277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACON CANCER CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-11",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "BARTELS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CADWELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-775-2804",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Rheumatology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.