Beau Taylor Vandiver, MD

Primary specialty

Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X

License

39047 Issued in AL

Practice address

2700 Highway 280 S Ste 300
Mountain BRK, AL 35223-2445

Phone

(205) 930-9595

Fax

(205) 802-7719

NPI assigned

May 2, 2018

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

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Rousso Facial Plastic Surgery Clinic PC

  • Specialist
  • Birmingham, AL
  • NPI 1225140627
  Medicare reassignment NPD
• Hedden Plastic Surgery

  • Plastic Surgery Physician
  • Birmingham, AL
  • NPI 1215989306
  NPD (past)
• HGD, Inc

  • Dermatology Physician
  • Mountain BRK, AL
  • NPI 1902439417
  NPD (past)

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1861981102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3894 GRANTS LN",
            "city": "IRONDALE",
            "state": "AL",
            "postal_code": "352105510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 HIGHWAY 280 S STE 300",
            "city": "MOUNTAIN BRK",
            "state": "AL",
            "postal_code": "352232445",
            "telephone_number": "205-930-9595",
            "fax_number": "205-802-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVER",
        "first_name": "BEAU",
        "middle_name": "TAYLOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-02",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "AL",
            "license": "39047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Henry Tytell, PSY.D.
• Charles Joel Underwood III, PT, DPT
• United Counseling
• United States Pharmaceutical Group, LLC
• Urostat Healthcare, Inc.
• Andrew Joseph Velazquez, MD
• Maegan Renee Vick, LPC
• Visionsouth PC
• Vulcan Performance Mountain Brook, LLC
• Vulcan Performance Rehabilitation and Recovery LLC

• Plastic Surgery Physician in Mountain BRK, AL
• Providers in Mountain BRK, AL by specialty
• Plastic Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.