Virgil A Beadle, DDX

Primary specialty

DentistTaxonomy code 122300000X

License

19A12875 Issued in IL

Practice address

#4 Crown Lane
Carbondale, IL 62903-7604

Phone

(618) 457-4137

Fax

(618) 351-1081

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609943091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#4 CROWN LANE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629037604",
            "telephone_number": "618-457-4137",
            "fax_number": "618-351-1081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#4 CROWN LANE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629037604",
            "telephone_number": "618-457-4137",
            "fax_number": "618-351-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEADLE",
        "first_name": "VIRGIL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDX",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "19A12875",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "010711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MISSOURI",
            "identifier": "010711",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS",
            "identifier": "19A12875",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hanad Ibrahim Bashir, MD
• Hailee Elizabeth Basler, NP-C
• Eric Christopher Batory, DO
• Antoinette Batson, NP
• Kelly Jean Bault
• Katina Beane
• Amanda Yvonne Beaver
• Christine J Begley, OD
• Behavioral Services of Southern Illinois Inc.
• Kaitlin Elizabeth Behnken, APRN, DNP, FNP-C

• Dentist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.