Beverly Atueyi, OD
Individual provider Active NPI Optometrist · Timonium, MD
NPI 1407438245 · NPPES record last updated Aug 2, 2022
Key facts
- NPI
- 1407438245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 390200000X (MD)
- Practice address
- 2391 Greenspring Dr
Timonium, MD 21093-3166 - Phone
- (800) 777-7904
- NPI assigned
- Apr 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Mid Atlantic States, Inc
Practice addresses (Care Compare)
2391 Greenspring Dr
Timonium, MD 21093-6038
Phone (301) 816-2424
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220811002100 | MD | Practitioner - Optometry | 5193108926 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 390200000X | MD | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients |
Locations
2101 E Jefferson St
#4E
Rockville, MD 20852
2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853
2391 Greenspring Dr
Timonium, MD 21093
Phone (410) 847-3000
6701 N Charles St
Towson, MD 21204
Phone (443) 849-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 390200000X | MD | Yes |
Addresses
Primary practice location
2391 Greenspring Dr
Timonium, MD 21093-3166
Mailing address
14 Vivian Vale CT
Randallstown, MD 21133-4310
Phone (410) 522-8633
Other practice location 1
1540 Spring Valley Dr
Huntington, WV 25704-9501
Phone (304) 429-6741
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Other providers in Timonium, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2022. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.