NPIMap

Organization Active NPI

Paul W Beaver OD PC

  • Optometrist
  • Sioux Center, IA
National Provider Identifier
1528043494
Registry record updated Mar 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1885 Issued in IA
Legal business name
PAUL W BEAVER OD PC
Practice address
105 S Main Ave
Sioux Center, IA 51250-1535
Phone
(712) 722-1270
Fax
(712) 722-1282
NPI assigned
Dec 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2008

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

Authorized official

Name
Mr. Paul W Beaver, ODNPI 1033392824
Title
Optometrist
Phone
(712) 722-1270

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1885 IA Primary

Addresses

Primary practice location

105 S Main Ave
Sioux Center, IA 51250-1535

Mailing address

105 S Main Ave
Sioux Center, IA 51250-1535
Phone (712) 722-1270

Other identifiers 2

IdentifierTypeStateIssuer
0282442MedicaidIA
28244OtherIABLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080122000723 IA Part B Supplier - Clinic/Group Practice 8820179369 Receives reassigned benefits from 4 practitioners
Practice locations: Sioux Center, IA

National Provider Directory

National Provider Directory

Locations

105 S Main Ave
Sioux Center, IA 51250
Phone (712) 722-1270

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206057600000",
    "number": "1528043494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S MAIN AVE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512501535",
            "telephone_number": "712-722-1270",
            "fax_number": "712-722-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S MAIN AVE",
            "city": "SIOUX CENTER",
            "state": "IA",
            "postal_code": "512501535",
            "telephone_number": "712-722-1270",
            "fax_number": "712-722-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL W BEAVER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2008-03-21",
        "status": "A",
        "authorized_official_last_name": "BEAVER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "712-722-1270",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0282442",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "28244",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Center, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.