Joshua Jeremiah Beardsley, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA936 Issued in SC

Practice address

200 S Herlong Ave
Suite B
Rock Hill, SC 29732-3399

Phone

(803) 327-8500

Fax

(803) 327-8505

NPI assigned

Jul 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1821097510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S HERLONG AVE",
            "address_2": "SUITE B",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323399",
            "telephone_number": "803-327-8500",
            "fax_number": "803-327-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S HERLONG AVE",
            "address_2": "SUITE B",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323399",
            "telephone_number": "803-327-8500",
            "fax_number": "803-327-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEARDSLEY",
        "first_name": "JOSHUA",
        "middle_name": "JEREMIAH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103940",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "PA936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00193752",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Surgical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; 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.