NPIMap

Organization Active NPI

Beulah Family Clinic Professional Limited Liability Company

  • Clinic/Center
  • Desoto, TX
National Provider Identifier
1750144150
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
BEULAH FAMILY CLINIC PROFESSIONAL LIMITED LIABILITY COMPANY
Practice address
1534-A N Hampton Road
Suite 100
Desoto, TX 75115-0073
Phone
(469) 585-8129
NPI assigned
Jan 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Patrick Moneke
Title
Administrator
Phone
(817) 366-0950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1534-A N Hampton Road
Suite 100
Desoto, TX 75115-0073

Mailing address

1534A N Hampton Rd
Desoto, TX 75115-2302

Other names 1

  • Beulah Medical Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240517000448 TX Part B Supplier - Clinic/Group Practice 3779924048 Receives reassigned benefits from 16 practitioners
Practice locations: Desoto, TX

National Provider Directory

National Provider Directory

Locations

1534 N Hampton Rd
Desoto, TX 75115

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BFGEDD

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1750144150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534A N HAMPTON RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1534-A N HAMPTON ROAD",
            "address_2": "SUITE 100",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751150073",
            "telephone_number": "469-585-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEULAH FAMILY CLINIC PROFESSIONAL LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "MONEKE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-366-0950"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beulah Medical Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Beulah Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.

Verify at the official NPI Registry.