Individual provider Active NPI

Megen Q Bejvan, PT

  • Physical Therapist
  • Appleton, WI
National Provider Identifier
1780237826
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14372 Issued in WI
Practice address
2500 E Capitol Dr
Appleton, WI 54911-8735
Phone
(920) 831-5050
NPI assigned
Jul 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05013138A IN
Physical Therapist 225100000X 14372 WI Primary

Addresses

Primary practice location

2500 E Capitol Dr
Appleton, WI 54911-8735

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 831-5050

Other practice location 1

3221 Beacon Pkwy Ste 100
Granger, IN 46530-7196
Phone (574) 647-2930

Other identifiers 2

IdentifierTypeStateIssuer
300028434MedicaidIN
IN3678024OtherINMEDICARE PTAN

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

State licenses

LicenseStateTypeSpecialty
05013138AINMDPhysical Therapist
14372WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Health, LLC Past Accepting new patients
Beacon Medical Group, Inc. PastSince Sep 1, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mbejvan323740@direct.thedacare.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1780237826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-831-5050",
            "fax_number": "920-735-7648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E CAPITOL DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118735",
            "telephone_number": "920-831-5050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3221 Beacon Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465307196",
            "country_code": "US",
            "telephone_number": "574-647-2930",
            "fax_number": "574-647-2935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEJVAN",
        "first_name": "MEGEN",
        "middle_name": "Q",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013138A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028434",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IN3678024",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.