Sally Beazlie-Walker, D.O
Individual provider Active NPI Family Medicine Physician · Plymouth, IN
NPI 1437312980 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1437312980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 02005023A (IN)
- Practice address
- 209 E Jefferson St
Plymouth, IN 46563-1861 - Phone
- (574) 948-5100
- Fax
- (574) 348-0745
- NPI assigned
- Jul 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tidewater Physicians Multispecialty Group, PC
Practice addresses (Care Compare)
2205 Executive Dr
Suite a
Hampton, VA 23666-2948
Phone (757) 223-4992
Hospital & facility affiliations
- Sentara Home Care Services
- Sentara Careplex Hospital
- Riverside Regional Medical Center
- Sentara Williamsburg Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110419001009 | VA | Practitioner - Family Practice | 7315122272 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02005023A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidewater Physicians Multispecialty Group PC | Current |
Accepting new patients | |
| Tidewater Physicians Multispecialty Group PC | Family Medicine | Current |
Accepting new patients |
| Sutter East Bay Medical Foundation | Past | Accepting new patients | |
| Sutter East Bay Medical Foundation | Family Medicine | Past | Accepting new patients |
Locations
2205 Executive Dr
Ste A
Hampton, VA 23666
Phone (757) 223-4992
860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138
860 Omni Blvd
Ste 101
Newport News, VA 23606
Phone (757) 223-9794
860 Omni Blvd
Ste 105
Newport News, VA 23606
Phone (757) 873-0952
729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077
827 Diligence Dr
Ste 100
Newport News, VA 23606
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BGFHDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02005023A | IN | Yes |
Addresses
Primary practice location
209 E Jefferson St
Plymouth, IN 46563-1861
Mailing address
707 Cedar St Ste 200
South Bend, IN 46617-2057
Phone (574) 335-8707
Other practice location 1
232 S Main St Ste 100
Culver, IN 46511-1648
Phone (574) 335-7780
Other practice location 2
2349 Lake Ave Ste 100
Plymouth, IN 46563-7836
Phone (574) 948-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 187720067 | Other | IN | MEDICARE PTAN |
| P01887772 | Other | IN | RR PTAN |
| 000001109741 | Other | IN | BCBS |
| 300004357 | Medicaid | IN |
Other names
- Dr. Sally Beazlie
Other providers in Plymouth, IN
- Michael Roy Baldwin
- Stephen J Barber
- Scott Kelley Barger
- Carlos Bastardo
- Beacon Medical Group, Inc.
- Bruce Farrell Becker
- Kelsey K Bell
- Teresa Benefit
- Berger Audiology
- Jeana Renee Berger
All providers in Plymouth, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. 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.