NPIMap

Organization Active NPI

St. Joseph Valley Anesthesia P.C.

  • Anesthesiology Physician
  • Mishawaka, IN
National Provider Identifier
1790738854
Registry record updated Feb 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ST. JOSEPH VALLEY ANESTHESIA P.C.
Practice address
5215 Holy Cross Parkway
Mishawaka, IN 46545-1469
Phone
(574) 335-5000
Fax
(574) 233-3125
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

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

Authorized official

Name
Dr. Darryl Beasley, M.D.
Title
President
Phone
(574) 233-3123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

5215 Holy Cross Parkway
Mishawaka, IN 46545-1469

Mailing address

PO Box 1742
South Bend, IN 46634-1742
Phone (574) 233-3123

Other identifiers 1

IdentifierTypeStateIssuer
200055220AMedicaidIN

National Provider Directory

National Provider Directory

Locations

335 Florence Ave
Ste B
Granger, IN 46530
Phone (574) 217-0058

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1790738854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1742",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466341742",
            "telephone_number": "574-233-3123",
            "fax_number": "574-233-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PARKWAY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-335-5000",
            "fax_number": "574-233-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH VALLEY ANESTHESIA P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-233-3123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200055220A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; 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.