Active NPI
Roland Ryan Beckman, CCP
- Perfusionist
- Idaho Falls, ID
National Provider Identifier
1730316787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 090909
- Practice address
- 156 S 45TH W
Idaho Falls, ID 83402-5542 - Phone
- (208) 521-6337
- Fax
- (650) 615-9995
- NPI assigned
- Jun 17, 2009
- 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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 090909 | CA | Primary |
Addresses
Primary practice location
156 S 45TH W
Idaho Falls, ID 83402-5542
Mailing address
156 S 45TH W
Idaho Falls, ID 83402-5542
Phone (208) 521-6337
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090909 | CA | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245196800000",
"number": "1730316787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 S 45TH W",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834025542",
"telephone_number": "208-521-6337",
"fax_number": "650-615-9995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 S 45TH W",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834025542",
"telephone_number": "208-521-6337",
"fax_number": "650-615-9995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKMAN",
"first_name": "ROLAND",
"middle_name": "RYAN",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-17",
"last_updated": "2009-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "CA",
"license": "090909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.