Roderick William Beaver, MD
Individual provider Active NPI Emergency Medicine Physician · Ilwaco, WA
NPI 1689615692 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1689615692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- MD00041270 (WA)
- Practice address
- 174 1St Ave N
Ilwaco, WA 98624-9137 - Phone
- (360) 448-0587
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Georgetown University School of Medicine, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Public Hospital District 3 of Pacific County
Practice addresses (Care Compare)
174 1St Ave N
Ilwaco, WA 98624-9137
Phone (360) 642-3181
Hospital & facility affiliations
- Ocean Beach Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060418000189 | WA | Practitioner - Emergency Medicine | 8729097845 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 224149 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District 3 of Pacific County | Current |
Accepting new patients | |
| Public Hospital District No 2, Klickitat County Washington | Current |
Accepting new patients | |
| Public Hospital District No. 2, Klickitat County, Washington | Current |
Accepting new patients | |
| Public Hospital District 3 of Pacific County | Current |
Accepting new patients | |
| Public Hospital District No 2, Klickitat County, Washington | Current |
Accepting new patients | |
| Public Hospital District 3 of Pacific County | Current |
Accepting new patients | |
| Peacehealth | Past | Accepting new patients | |
| Peacehealth | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/ac6e817f-dc27-43e8-b886-6559f137e853/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD00041270 | WA | Yes |
Addresses
Primary practice location
174 1St Ave N
Ilwaco, WA 98624-9137
Mailing address
34400 NE Lester Ave
La Center, WA 98629-3413
Phone (360) 448-0587
Other practice location 1
211 NE Skyline Dr
White Salmon, WA 98672-1948
Phone (509) 493-1101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1016271 | Medicaid | WA | |
| 8323198 | Medicaid | WA |
Other providers in Ilwaco, WA
All providers in Ilwaco, WA · Emergency Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.