Stacy Beaty, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2005004429 Issued in MO

Practice address

1755 S Grand
St Louis, MO 63104

Phone

(314) 256-3433

Fax

(314) 256-3431

NPI assigned

Jul 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

Dermatology

Education

University of Texas Medical Branch at Galveston, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Tarrant Dermatology IncGroup PAC ID 6002801164, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northeast Tarrant Dermatology, Inc

  • Dermatology Physician
  • Hurst, TX
  • NPI 1235357666
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669499638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3691 RUTGER AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-977-6828",
            "fax_number": "314-977-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 S GRAND",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-256-3433",
            "fax_number": "314-256-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEATY",
        "first_name": "STACY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2005004429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Beattie
• Adriena Cothron Beatty, D.O.
• Kristen D Beatty, LMSW
• Monet Beatty
• Diana Kay Beaty, NNP
• Olivia Beaubrun, MD
• Tatyana Beaubrun, MD
• Jakeia Kiarra Beauford I
• Beautification Concepts LLC (Vein Skin Care Institute)
• Beauvais Manor

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.