NPIMap

Individual provider Active NPI

Roderick William Beaver, MD

  • Emergency Medicine Physician
  • Ilwaco, WA
National Provider Identifier
1689615692
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD00041270 Issued in WA
Practice address
174 1St Ave N
Ilwaco, WA 98624-9137
Phone
(360) 448-0587
NPI assigned
Jun 9, 2006
Last updated
Dec 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD00041270 WA Primary

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 2

IdentifierTypeStateIssuer
8323198MedicaidWA
1016271MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060418000189 WA Practitioner - Emergency Medicine 8729097845 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Georgetown University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

174 1St Ave N
Ilwaco, WA 98624-9137
Phone (360) 642-3181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00041270WAMDEmergency Medicine Physician
224149NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District 3 of Pacific County CurrentSince Mar 1, 2022 Accepting new patients
Public Hospital District 3 of Pacific County CurrentSince Mar 1, 2022 Accepting new patients
Public Hospital District No 2, Klickitat County, Washington CurrentSince Nov 1, 2022 Accepting new patients
Public Hospital District 3 of Pacific County CurrentSince Mar 1, 2022 Accepting new patients
Public Hospital District No. 2, Klickitat County, Washington CurrentSince Jul 1, 2025 Accepting new patients
Public Hospital District No 2, Klickitat County Washington CurrentSince Nov 1, 2022 Accepting new patients
Peacehealth Past Accepting new patients
Peacehealth Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/ac6e817f-dc27-43e8-b886-6559f137e853/

Organizations & group practices 9

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1689615692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34400 NE LESTER AVE",
            "city": "LA CENTER",
            "state": "WA",
            "postal_code": "986293413",
            "telephone_number": "360-448-0587",
            "fax_number": "360-263-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 1ST AVE N",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986249137",
            "telephone_number": "360-448-0587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 NE Skyline Dr",
            "address_purpose": "LOCATION",
            "city": "White Salmon",
            "state": "WA",
            "postal_code": "986721948",
            "country_code": "US",
            "telephone_number": "509-493-1101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "RODERICK",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00041270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8323198",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016271",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ilwaco, WA

Sources for this page

Verify at the official NPI Registry.