Jackie Beene, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R1I02 Issued in MO

Practice address

1540 E Evergreen St
Springfield, MO 65803-4300

Phone

(417) 823-2900

Fax

(417) 886-2774

NPI assigned

Jun 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Arkansas College of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ozarks Community Hospital of Gravette Hospital, Gravette, AR, CCN 041331

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sgoh Acquisition Inc

  • Clinic/Center
  • Springfield, MO
  • NPI 1114924768
  Medicare reassignment Care Compare group
• Primrose Nephrology, Inc.

  • Specialist
  • Springfield, MO
  • NPI 1225163116
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sgoh Acquisition Inc

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Care Compare affiliation

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1841296548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 E EVERGREEN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034300",
            "telephone_number": "417-823-2900",
            "fax_number": "417-886-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 E EVERGREEN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034300",
            "telephone_number": "417-823-2900",
            "fax_number": "417-886-2774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "327 E Airport Dr",
            "address_purpose": "LOCATION",
            "city": "Carthage",
            "state": "MO",
            "postal_code": "648363402",
            "country_code": "US",
            "telephone_number": "417-237-0604",
            "fax_number": "417-237-0613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "112 N Webb St",
            "address_purpose": "LOCATION",
            "city": "Webb City",
            "state": "MO",
            "postal_code": "648701916",
            "country_code": "US",
            "telephone_number": "417-673-0366",
            "fax_number": "417-673-0093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEENE",
        "first_name": "JACKIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R1I02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00065361",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202538732",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Beckham, MS CC SLP
• Tracy L Beckham, CRNA
• Alexandra Kozuma Beckman, BCBA
• Reagan Bedell, PA-C
• Natalie Beeler, MA, LPC, NCC
• Nicholas Beese
• Christina C Begay, LMSW
• Everett A Beguin Jr., M.D.
• Behavior Based Learning, LLC
• Behavioral and Integrative Health

• Family Medicine Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.