NPIMap

Individual provider Active NPI

Beau Braden

  • Emergency Medicine Physician
  • Ave Maria, FL
National Provider Identifier
1902044985
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS12519 Issued in FL
Practice address
5050 Ave Maria Blvd
Ave Maria, FL 34142-9505
Phone
(239) 867-4395
Fax
(239) 217-3662
NPI assigned
Jan 28, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Toxicology (Emergency Medicine) Physician 207PT0002X OS12519 FL
Emergency Medicine Physician 207P00000X OS12519 FL Primary
General Practice Physician 208D00000X OS12519 FL
Addiction Medicine (Family Medicine) Physician 207QA0401X OS12519 FL

Addresses

Primary practice location

5050 Ave Maria Blvd
Ave Maria, FL 34142-9505

Mailing address

5050 Ave Maria Blvd
Ave Maria, FL 34142-9505
Phone (239) 867-4395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131008001363 NE Practitioner - Emergency Medicine 0648454090
I20170306001430 TX Practitioner - Emergency Medicine 0648454090 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
997NEMDAddiction (Substance Use Disorder) Counselor
OS12519FLMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians Emergency Medicine of Texas PLLC Emergency Medicine CurrentSince Feb 16, 2018 Accepting new patients
Texas Emergency Room Services PA Emergency Medicine Past Accepting new patients
Shamrock Community Hospital Inc. PastSince Jan 23, 2021 Accepting new patients

Locations

2830 Calder St
Beaumont, TX 77702
Phone (409) 899-7000

1275 Marvin Hancock Dr
Jasper, TX 75951
Phone (409) 384-1951

3600 Gates Blvd
Port Arthur, TX 77642
Phone (409) 985-7431

Ownership & related parties

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Henderson County Community HospitalLexington, TN, CCN 440008 Hospital Corporate Officer
Corporate Director		 Apr 1, 2020
Apr 1, 2020
Henderson County Community HospitalLexington, TN, CCN 44U008 Hospital Corporate Officer
Corporate Director		 Apr 1, 2020
Apr 1, 2020
Houston County Community HospitalErin, TN, CCN 441322 Hospital 5% Or Greater Direct Ownership Interest
Corporate Officer
Corporate Director		 Aug 1, 2022
Aug 1, 2022
Aug 1, 2022
Haywood County Community Hospital IncBrownsville, TN, CCN 440238 Hospital 5% Or Greater Direct Ownership Interest
Corporate Officer
Corporate Director		 May 7, 2021
May 7, 2021
May 7, 2021
Houston County Community HospitalErin, TN, CCN 44Z322 Hospital 5% Or Greater Direct Ownership Interest
Corporate Officer
Corporate Director		 Aug 1, 2022
Aug 1, 2022
Aug 1, 2022
Perry County Community HospitalLinden, TN, CCN 441325 Hospital Corporate Director Aug 19, 2024
Perry County Community Hospital IncLinden, TN, CCN 44Z325 Hospital Corporate Officer
Corporate Director		 Aug 19, 2024
Aug 19, 2024
Stuart Community HospitalStuart, VA, CCN 491310 Hospital Corporate Director Feb 13, 2025
Stuart Community HospitalStuart, VA, CCN 49Z310 Hospital Corporate Director Feb 13, 2025
Henderson County Medical Group RHCLexington, TN, CCN 443447 Rural health clinic Corporate Officer Apr 1, 2020
Scotts Hill Clinic RHCLinden, TN, CCN 443470 Rural health clinic Corporate Officer
Corporate Director		 Apr 1, 2020
Apr 1, 2020

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1902044985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 AVE MARIA BLVD",
            "city": "AVE MARIA",
            "state": "FL",
            "postal_code": "341429505",
            "telephone_number": "239-867-4395",
            "fax_number": "239-217-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 AVE MARIA BLVD",
            "city": "AVE MARIA",
            "state": "FL",
            "postal_code": "341429505",
            "telephone_number": "239-867-4395",
            "fax_number": "239-217-3662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADEN",
        "first_name": "BEAU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-28",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PT0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Medical Toxicology",
            "state": "FL",
            "license": "OS12519",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS12519",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS12519",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "FL",
            "license": "OS12519",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ave Maria, FL

Sources for this page

Verify at the official NPI Registry.