Beulah T. Penumudi, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11433 Issued in NV

Practice address

2121 Lake Ave
VA Northern Indiana Health Care System
Fort Wayne, IN 46805-5100

Phone

(260) 426-5431

Fax

(260) 426-5431

NPI assigned

Jan 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• HMC Medical Center, LLC

  • Urgent Care Clinic/Center
  • Las Vegas, NV
  • NPI 1194754358
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1750434486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "address_2": "VA NORTHERN INDIANA HEALTH CARE SYSTEM",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431",
            "fax_number": "260-426-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "address_2": "VA NORTHERN INDIANA HEALTH CARE SYSTEM",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431",
            "fax_number": "260-426-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENUMUDI",
        "first_name": "BEULAH",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "11433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "CS12529",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA MEDICAL LICENSE",
            "identifier": "11433",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Penn, RBT
• James H. Pennington, O.D.
• Matthew M Pennucci, DPT
• Phillip Craig Penny I, D.O.
• Christina Anita Pentsos, RN
• People and Pathways Consulting LLC
• People of Conviction
• Evan Pepple, RBT
• Shana Marie Pepple, MA, BCBA
• Stephan Edwin Pepple, M.D.

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.