Individual provider Active NPI

Shaun Michael Bezak, D.C.

  • Chiropractor
  • Greenbelt, MD
National Provider Identifier
1871685677
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S02141 Issued in MD
Practice address
7500 Hanover Pkwy Ste 102
Greenbelt, MD 20770-2011
Phone
(301) 220-0496
Fax
(301) 220-2303
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X SO2141 MD
Chiropractor 111N00000X S02141 MD Primary

Addresses

Primary practice location

7500 Hanover Pkwy Ste 102
Greenbelt, MD 20770-2011

Mailing address

7500 Hanover Pkwy Ste 102
Greenbelt, MD 20770-2011
Phone (301) 220-0496

Other identifiers 9

IdentifierTypeStateIssuer
1039615OtherMDASHN/CIGNA
61837201OtherMDBLUE CROSS BLUE SHIELD MD
7879466OtherMDAETNA/PROVIDER NON HMO
G7520001OtherMDBLUE CROSS BLUE SHIELD DC
2319509OtherMDUNITED HEALTHCARE
2096855OtherMDFIRST HEALTH/MAILHANDLERS
2120465OtherMDMAMSI/MDIPA/OPT./ALLIANCE
652647OtherMDACN
3137927OtherMDAETNA PROVIDER HMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111215000283 DC Practitioner - Chiropractic 1153596432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7500 Hanover Pkwy
Suite 102
Greenbelt, MD 20770-2011
Phone (301) 220-0496

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S02141MDMDChiropractor
SO2141MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bezak Chiropractic and Rehabilitation, P.a. Chiropractor CurrentSince Mar 1, 2003 Accepting new patients

Locations

7415 Greenbelt Rd
Greenbelt, MD 20770
Phone (301) 220-0496

7500 Hanover Pkwy
Ste 102
Greenbelt, MD 20770
Phone (301) 220-0496

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1871685677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 HANOVER PKWY STE 102",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207702011",
            "telephone_number": "301-220-0496",
            "fax_number": "301-220-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 HANOVER PKWY STE 102",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207702011",
            "telephone_number": "301-220-0496",
            "fax_number": "301-220-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEZAK",
        "first_name": "SHAUN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "SO2141",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S02141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHN/CIGNA",
            "identifier": "1039615",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MD",
            "identifier": "61837201",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/PROVIDER NON HMO",
            "identifier": "7879466",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD DC",
            "identifier": "G7520001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2319509",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH/MAILHANDLERS",
            "identifier": "2096855",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI/MDIPA/OPT./ALLIANCE",
            "identifier": "2120465",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "652647",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER HMO",
            "identifier": "3137927",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbelt, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.