NPIMap

Organization Active NPI

Beaumont ER Physicians PLLC

  • Emergency Medicine Physician
  • Beaumont, TX
National Provider Identifier
1629404637
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
BEAUMONT ER PHYSICIANS PLLC
Practice address
4004 College St
Beaumont, TX 77707-4004
Phone
(713) 343-9651
Fax
(409) 515-1121
NPI assigned
Sep 23, 2013
Last updated
Apr 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Authorized official

Name
Dr. Shannon Orsak, MDNPI 1144241928
Title
President
Phone
(281) 343-9975

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X NU
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

4004 College St
Beaumont, TX 77707-4004

Mailing address

12743 Capricorn St Ste 400
Stafford, TX 77477-3996
Phone (713) 343-9651

Other identifiers 1

IdentifierTypeStateIssuer
00567JOtherTXBLUE CROSS BLUE SHIELD

Other names 1

  • Beaumont ER Physicians Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140807000735 TX Part B Supplier - Clinic/Group Practice 1254558794 Receives reassigned benefits from 5 practitioners
Practice locations: Beaumont, TX

National Provider Directory

National Provider Directory

Locations

12743 Capricorn St
Ste 400
Stafford, TX 77477

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1629404637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12743 CAPRICORN ST STE 400",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774773996",
            "telephone_number": "713-343-9651",
            "fax_number": "409-515-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 COLLEGE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777074004",
            "telephone_number": "713-343-9651",
            "fax_number": "409-515-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT ER PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-23",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "ORSAK",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "281-343-9975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00567J",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaumont ER Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.