Beavertown Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35052219R Issued in OH

Legal business name

BEAVERTOWN CLINIC INC

Practice address

3017 Wilmington Pike
Kettering, OH 45429-4169

Phone

(937) 294-2555

Fax

(937) 294-3211

NPI assigned

Jul 7, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Bernard J Rose, M.D.NPI 1508864042

Title

Physician

Phone

(937) 294-2555

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bernard J Rose, M.D.

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1508864042
  Medicare reassignment NPD Authorized official
• Catherine Marie Rose, FNP-C, APRN, CNP, RN

  • Primary Care Nurse Practitioner
  • Kettering, OH
  • NPI 1982391835
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266883200000",
    "number": "1902803703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 WILMINGTON PIKE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294169",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 WILMINGTON PIKE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294169",
            "telephone_number": "937-294-2555",
            "fax_number": "937-294-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERTOWN CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-02-23",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "937-294-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35052219R",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35058825R",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R00609981",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea M Bayliss, CRNA
• Joseph Victor Bean, DDS
• Nancy E Beane, CRNA
• Miah Beatty, PTA
• Beautiful Me, LLC
• Becca'S 3700 Hair Studio, Inc
• Wenxia Becker, MD
• Richard Thomas Beers, M.D.
• Lauren Behr
• Kevin Beireis, RPH

• Family Medicine Physician in Kettering, OH
• Providers in Kettering, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; 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.