Active NPI
Carl Joseph Beaudry, M.D.
- Specialist
- Port Arthur, TX
National Provider Identifier
1750338380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- E9531
- Practice address
- 2501 Jimmy Johnson Blvd
Suite 202
Port Arthur, TX 77640-2007 - Phone
- (409) 722-4446
- Fax
- (409) 722-4448
- NPI assigned
- May 28, 2006
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | E9531 | TX | Primary |
Addresses
Primary practice location
2501 Jimmy Johnson Blvd
Suite 202
Port Arthur, TX 77640-2007
Mailing address
2501 Jimmy Johnson Blvd
Suite 202
Port Arthur, TX 77640-2007
Phone (409) 722-4446
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097777901 | Medicaid | TX | |
| E9531 | Other | TX | PHYSICIAN PERMIT |
| 687562 | Other | TX | AETNA |
| CIGNA | Other | TX | 3739015001 |
| 0082GS | Other | TX | BLUE CROSS |
| S0033018 | Other | TX | DPS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E9531 | TX | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1750338380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 JIMMY JOHNSON BLVD",
"address_2": "SUITE 202",
"city": "PORT ARTHUR",
"state": "TX",
"postal_code": "776402007",
"telephone_number": "409-722-4446",
"fax_number": "409-722-4448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 JIMMY JOHNSON BLVD",
"address_2": "SUITE 202",
"city": "PORT ARTHUR",
"state": "TX",
"postal_code": "776402007",
"telephone_number": "409-722-4446",
"fax_number": "409-722-4448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUDRY",
"first_name": "CARL",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-28",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "E9531",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "097777901",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN PERMIT",
"identifier": "E9531",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "687562",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "3739015001",
"identifier": "CIGNA",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0082GS",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DPS",
"identifier": "S0033018",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Arthur, TX
- Baylor Pathology Consultants (Baylor College of Medicine)
- Beach Bay and Tackle LLC Dba Home Care Provider Service (Home Care Provider Service)
- Eric Bruce Beal, D.C.
- Nicholas Benjamin Beamon
- Bean Development, LLC
- Beaumont Hospital Holdings Inc
- Beckman Audiology PLLC
- Teryn Bedford, MS, CCC-SLP
- Dianna Velicia Belaire, NP-C
- Melanie K Bell, P.A.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.