Gale Rolland Beardsley Jr., M.D.
Individual provider Active NPI Psychiatry Physician · Honolulu, HI
NPI 1790789600 · NPPES record last updated May 7, 2021
Key facts
- NPI
- 1790789600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- G151697 (CA)
- Practice address
- 1629 Wilder Ave Apt 704
Honolulu, HI 96822-4666 - Phone
- (808) 721-7278
- Fax
- (808) 207-3799
- NPI assigned
- Jun 8, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210625001621 | CA | Practitioner - Psychiatry | 0749322527 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G151697 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Butte | Current |
Accepting new patients | |
| County of Butte | Current | Accepting new patients | |
| County of Butte | Current |
Accepting new patients |
Locations
560 Cohasset Rd
Ste 175
Chico, CA 95926
Phone (530) 552-5076
3217 Cohasset Rd
Cohasset, CA 95973
Phone (530) 552-4578
995 Spruce St
Gridley, CA 95948
Phone (530) 846-7305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD4083 | HI | |
| Psychiatry Physician | 2084P0800X | G151697 | CA | Yes |
Addresses
Primary practice location
1629 Wilder Ave Apt 704
Honolulu, HI 96822-4666
Mailing address
1629 Wilder Ave Apt 704
Honolulu, HI 96822-4666
Phone (808) 721-7278
Other practice location 1
600 Kapiolani Blvd
Ste 402
Honolulu, HI 96813-5141
Phone (808) 537-2665
Other practice location 2
2550 W Clinton Ave Bldg W
Fresno, CA 93705-4206
Phone (808) 721-7278
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04758501 | Medicaid | HI |
Other providers in Honolulu, HI
- Liezl Zeta Beall
- John Francis Beamis Jr.
- Cameron Bean
- Kellen Bean
- Kylie Bean
- Rebecca Marie Beardsley
- Amy Renee Beasley
- Darlene Beatty
- Samantha K Beaumont
- Rhiana Kai Beauregard
All providers in Honolulu, HI · Psychiatry Physician in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.