Individual provider Active NPI

Stephen Beasley

  • Gastroenterology Physician
  • Lawrenceville, GA
National Provider Identifier
1568897668
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
84807 Issued in GA
Practice address
763 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone
(678) 985-2000
NPI assigned
Sep 8, 2013
Last updated
Jun 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 390200000X - GA
Gastroenterology Physician 207RG0100X 84807 GA Primary

Addresses

Primary practice location

763 Old Norcross Rd
Lawrenceville, GA 30046-4317

Mailing address

763 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone (678) 985-2000

Other practice location 1

4700 Waters Ave
Savannah, GA 31404-6220
Phone (912) 350-1734

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.southern-gastro.com/lawrenceville-gastroenterology-office.php Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181226002483 AL Practitioner - Internal Medicine 4789934589 Reassigns benefits to 1 organization
I20201118002462 GA Practitioner - Internal Medicine 4789934589 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Mercer University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Gastroenterology Associates, LLCGroup PAC ID 8820084064, 8 clinicians

Practice addresses (Care Compare)

763 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone (678) 985-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy82
Upper gastrointestinal (GI) endoscopy for acid reflux63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
390200000X -GAMDInternal Medicine Physician
84807GAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Gastroenterology Associates, LLC Gastroenterology CurrentSince Aug 25, 2020 Accepting new patients
University of South Alabama CurrentSince Oct 31, 2018 Accepting new patients
University of South Alabama Internal Medicine CurrentSince Oct 31, 2018 Accepting new patients
University of South Alabama Internal Medicine Current Accepting new patients

Locations

1660 Spring Hill Ave
Mobile, AL 36604
Phone (251) 445-9616

1660 Spring Hill Ave
Ste 3069
Mobile, AL 36604
Phone (251) 445-8405

2451 University Hospital Dr
Mobile, AL 36617
Phone (251) 471-7000

75 S University Blvd
Ste 6000A
Mobile, AL 36608
Phone (251) 660-5787

763 Old Norcross Rd
Lawrenceville, GA 30046
Phone (678) 985-1994

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1378598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1568897668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464317",
            "telephone_number": "678-985-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464317",
            "telephone_number": "678-985-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4700 Waters Ave",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314046220",
            "country_code": "US",
            "telephone_number": "912-350-1734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "STEPHEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-08",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "390200000X -",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "84807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.southern-gastro.com/lawrenceville-gastroenterology-office.php",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "website",
            "address_1": "763 Old Norcross Rd",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300464317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.