Jack Juan Beller, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

9412 Issued in OK

Practice address

3301 NW 50TH St
Oklahoma City, OK 73112-5627

Phone

(405) 947-0911

NPI assigned

Jul 13, 2005

Last updated

Sep 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Wewoka Indian Health

  • Community Health Clinic/Center
  • Wewoka, OK
  • NPI 1689664195

  TX

  Medicare reassignment NPD
• Norman Regional Sports & Occupational Medicin

  dba NRH Occupational Medicine

  • Occupational Medicine Physician
  • Norman, OK
  • NPI 1598847337
  NPD (past)
• Orthopaedic and Sports Medicine Center-Norman, P.C.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Norman, OK
  • NPI 1306854765
  NPD (past)

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1437157344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 NW 50TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125627",
            "telephone_number": "405-947-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 NW 50TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125627",
            "telephone_number": "405-947-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLER",
        "first_name": "JACK",
        "middle_name": "JUAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "9412",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OK",
            "license": "9412",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OK",
            "license": "9412",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR RAILROAD",
            "identifier": "P00777384",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100110450A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth David Bellamy
• Abigail Bellatti
• Joseph Aaron Bellatti, OTR
• Bellecare Inc. (Northwest Nursing Center)
• Chuck Bellefeuille
• Bellevue Northwest Nursing Center, LLC (Bellevue Health & Rehabilitation Center)
• Thomas Bellew, PHARMD
• Samantha Bellinger, A.P.R.N.
• Mackenzie Elyse Bellmer, PHYSICIAN ASSISTANT
• Sara Mahmoud Bellusa

• Specialist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.