Active NPI
Charles Merritt Beasley Jr., M.D.
- Psychiatry Physician
- Indianapolis, IN
National Provider Identifier
1730390873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 01045668A
- Practice address
- 8161 Beech KNLS
Indianapolis, IN 46256-2107 - Phone
- (317) 578-2714
- Fax
- (317) 578-2801
- NPI assigned
- May 24, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 01045668A | IN | Primary |
Addresses
Primary practice location
8161 Beech KNLS
Indianapolis, IN 46256-2107
Mailing address
8161 Beech KNLS
Indianapolis, IN 46256-2107
Phone (317) 578-2714
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01045668A | Other | IN | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730390873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8161 BEECH KNLS",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462562107",
"telephone_number": "317-578-2714",
"fax_number": "317-578-2801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8161 BEECH KNLS",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462562107",
"telephone_number": "317-578-2714",
"fax_number": "317-578-2801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEASLEY",
"first_name": "CHARLES",
"middle_name": "MERRITT",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IN",
"license": "01045668A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "01045668A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.