Gary D Beauchamp, MD
Individual provider Active NPI Cardiovascular Disease Physician · Liberty, MO
NPI 1528080686 · NPPES record last updated Dec 18, 2013
Key facts
- NPI
- 1528080686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- R5969 (MO)
- Practice address
- 1530 N Church Rd
Liberty, MO 64068-7129 - Phone
- (816) 781-1696
- Fax
- (816) 781-5438
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-14844 | KS | MD | Cardiovascular Disease Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | R5969 | MO | Yes |
| Cardiovascular Disease Physician | 207RC0000X | 04-14844 | KS |
Addresses
Primary practice location
1530 N Church Rd
Liberty, MO 64068-7129
Mailing address
5501 NW 62ND Ter
Suite 201
Kansas City, MO 64151-2411
Phone (816) 584-8884
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225043 | Other | HEALTHLINK-NCPPO | |
| 4001285 | Other | MO & KS / AETNA PPO & HMO | |
| 557640 | Other | FAMILY HEALTH PARTNERS | |
| 151824XX | Other | PREFERRED CARE NY | |
| 504290 | Other | FIRST GUARD HLTH PLAN | |
| 10001216901 | Other | COMMUNITY HLTH PLAN OF MO | |
| 100202570A | Medicaid | KS | |
| 051563 | Other | KS | BCBS KS OUTREACH CLINICS |
| 04472015 | Other | BCBS KC | |
| 200019503 | Medicaid | MO | |
| 100202570B | Medicaid | KS |
Other providers in Liberty, MO
- Jahlah Kae Baum
- Amy Bax
- Jessica Jane Baxter
- Mark Bryan Beard
- Rodney Lee Beard
- Deborah Propst Becker
- Julie L Becker
- Keiley Beckstead
- William M Bednar
- Michael Scott Beeler
All providers in Liberty, MO · Cardiovascular Disease Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.