NPIMap

Organization Active NPI

Beacon Behavioral Pediatric Clinic LLC

Doing business as Beacon Behavioral Pediatrics

  • Primary Care Clinic/Center
  • Munster, IN
National Provider Identifier
1497453252
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BEACON BEHAVIORAL PEDIATRIC CLINIC LLC
Doing business as
Beacon Behavioral Pediatrics
Practice address
8933 White Oak Ave
Munster, IN 46321-3134
Phone
(219) 838-7703
NPI assigned
Feb 21, 2023
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Authorized official

Name
Dr. Anna Adekugbe, MDNPI 1982999751
Title
President
Phone
(617) 308-1720

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

8933 White Oak Ave
Munster, IN 46321-3134

Mailing address

8933 White Oak Ave
Munster, IN 46321-3134
Phone (617) 308-1720

Other names 1

  • Beacon Behavioral Pediatrics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1497453252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8933 WHITE OAK AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213134",
            "telephone_number": "617-308-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8933 WHITE OAK AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213134",
            "telephone_number": "219-838-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON BEHAVIORAL PEDIATRIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "ADEKUGBE",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-308-1720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Behavioral Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Behavioral Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Munster, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.