Samuel W Beenken, MD
Individual provider Active NPI Pain Medicine Physician · Birmingham, AL
NPI 1801830815 · NPPES record last updated Jan 29, 2018
Key facts
- NPI
- 1801830815
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine Physician 208VP0000X
- License
- PM.552 (AL)
- Practice address
- 5510 Highway 280
Suite 215
Birmingham, AL 35242-6582 - Phone
- (205) 624-4325
- Fax
- (205) 620-6776
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- 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 |
|---|---|---|---|---|
| I20160309000141 | AL | Order and Referring Only - General Practice |
3971809526 |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15438 | AL | MD | General Practice Physician |
| PM.552 | AL | MD | Pain Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15438 | AL | |
| Pain Medicine Physician | 208VP0000X | PM.552 | AL | Yes |
Addresses
Primary practice location
5510 Highway 280
Suite 215
Birmingham, AL 35242-6582
Mailing address
176 Bonnieville Dr
Calera, AL 35040-3606
Phone (205) 478-7575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020016114 | Other | AL | RAILROAD MEDICARE |
| 000082627 | Other | AL | BLUE CROSS |
| 000082627 | Medicaid | AL | |
| E50317 | Other | AL | VIVA |
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All providers in Birmingham, AL · Pain Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2018. 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.