Active NPI
Charles Jeffrey Beach, PA
- Physician Assistant
- Winston-Salem, NC
National Provider Identifier
1669434148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 100198
- Practice address
- 140 Kimel Park Dr
Winston-Salem, NC 27103-6946 - Phone
- (336) 245-2100
- Fax
- (336) 765-6135
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 100198 | NC | Primary |
Addresses
Primary practice location
140 Kimel Park Dr
Winston-Salem, NC 27103-6946
Mailing address
2000 Frontis Plaza Blvd Ste 200
Attn Forsyth Medical Group
Winston Salem, NC 27103-5616
Phone (336) 277-2436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100198 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188345600000",
"number": "1669434148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 FRONTIS PLAZA BLVD STE 200",
"address_2": "ATTN FORSYTH MEDICAL GROUP",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271035616",
"telephone_number": "336-277-2436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 KIMEL PARK DR",
"city": "WINSTON-SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-245-2100",
"fax_number": "336-765-6135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEACH",
"first_name": "CHARLES",
"middle_name": "JEFFREY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2007-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "100198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston-Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.