Beacon Cancer Care PLLC
Organization Active NPI Multi-Specialty Clinic/Center · Coeur D Alene, ID
NPI 1407335367 · NPPES record last updated Aug 25, 2023
Key facts
- NPI
- 1407335367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- BEACON CANCER CARE PLLC
- 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
- Organization subpart
- No
Authorized official
- Name
- Dr. David Cadwell Bartels, DO
- Title
- Owner
- Phone
- (208) 775-2804
Subparts reporting this organization as parent 1
Practitioners 21
-
Stephanie Ann Hart, ARNP
-
Gretchen Renee Helvey, MSN, AGNP-C
-
Danko Martincic, MD
-
Rebecca Marie Meyer, APRN, CNP
-
Cannon Milani, MD
-
Jessica M Herr, FNP
-
Carl J Walker, MD
-
Howard M Kenney, M.D.
-
Jared G Heiner, M.D.
-
Ashley Jenkins, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
8854 W Emerald St
Ste 180
Boise, ID 83704
Phone (208) 229-9009
8950 W Emerald St
Ste 108
Boise, ID 83704
Phone (208) 672-8682
3815 N Schreiber Way
Unit 101
Coeur D Alene, ID 83815
Phone (208) 755-2804
3815 N Schreiber Way
Coeur D Alene, ID 83815
30544 Highway 200
Ste 302
Ponderay, ID 83852
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology (Internal Medicine) Physician |
207RH0000X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Rheumatology Physician |
207RR0500X | |||
| Medical Oncology Physician |
207RX0202X | |||
| Radiation Oncology Physician |
2085R0001X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes | ||
| Oncology Clinic/Center | 261QX0200X | |||
| Radiation Oncology Clinic/Center | 261QX0203X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407335367 | Medicaid | ID | |
| 2107483 | Medicaid | WA |
Other names
- Beacon Clinic
- Beacon Rheumatology
Other providers in Coeur D Alene, ID
- Michelle L Baxter
- Tyler Mitchell Baxter
- Be Well Therapy Group of Idaho PLLC
- Erika Jean Beachler
- Beachside Counseling LLC
- Beacon Cancer Care PLLC
- Matthew C. Bean
- Robin Marie Beard
- Britta Beasley
- Beatific Behavior Services, Inc
All providers in Coeur D Alene, ID · Multi-Specialty Clinic/Center in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.