Beth Gingrich Deckard, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP005262B Issued in PA

Practice address

21 Susquehanna Valley Mall Dr Ste a
Selinsgrove, PA 17870-9148

Phone

(570) 374-7852

Fax

(570) 374-7932

NPI assigned

Jun 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Beth E Gingrich Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bethdeckardcrnp@fpc.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Practice Center, PC

  • Physical Therapist
  • Middleburg, PA
  • NPI 1154376937

  Nurse Practitioner

  Medicare reassignment NPD
• Family Practice Center, PC

  • Clinical Medical Laboratory
  • Selinsgrove, PA
  • NPI 1033322466
  NPD

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1619916111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 SUSQUEHANNA VALLEY MALL DR STE A",
            "city": "SELINSGROVE",
            "state": "PA",
            "postal_code": "178709148",
            "telephone_number": "570-374-7852",
            "fax_number": "570-374-7932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKARD",
        "first_name": "BETH",
        "middle_name": "GINGRICH",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP005262B",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN266917L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1031841380001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BethDeckardCRNP@fpc.medentdirect.com",
            "affiliation": "Y",
            "affiliationName": "FAMILY PRACTICE CENTER, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "21 Susquehanna Valley Mall Dr Ste A",
            "city": "Selinsgrove",
            "state": "PA",
            "country_code": "US",
            "postal_code": "178709148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "GINGRICH",
            "middle_name": "E",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Selinsgrove, PA
• Providers in Selinsgrove, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.