Active NPI
Jessica Sue Beach, OTR
- Occupational Therapist
- Gladwin, MI
National Provider Identifier
1730451311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201008148
- Practice address
- 449 Quarter St
Gladwin, MI 48624-1918 - Phone
- (989) 426-3430
- NPI assigned
- Jan 30, 2012
- Last updated
- Jan 30, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5201008148 | MI | Primary |
Addresses
Primary practice location
449 Quarter St
Gladwin, MI 48624-1918
Mailing address
803 Hemlock St
Midland, MI 48642-6342
Phone (989) 708-1212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5201008148 | Other | MI | BOARD OF OCCUPATIONAL THERAPY |
Other names 1
- Jessica Sue Ellis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
-
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- Physical Therapist
- Shelby Township, MI
- NPI 1912226366
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327881600000",
"number": "1730451311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "803 HEMLOCK ST",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486426342",
"telephone_number": "989-708-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "449 QUARTER ST",
"city": "GLADWIN",
"state": "MI",
"postal_code": "486241918",
"telephone_number": "989-426-3430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEACH",
"first_name": "JESSICA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-30",
"last_updated": "2012-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201008148",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF OCCUPATIONAL THERAPY",
"identifier": "5201008148",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "ELLIS",
"middle_name": "SUE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Gladwin, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.