Jacalyn R Beavers

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802083584 Issued in MI

Practice address

29877 Telegraph Rd
Ste 401
Southfield, MI 48034-7661

Phone

(248) 358-5334

Fax

(248) 356-7596

NPI assigned

Aug 31, 2006

Sex

Female

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jacalynbeavers@tdh.allscriptsdirect.net

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.

• Selective Home Counseling Service

  • Physical Disabilities Residential Treatment Facility
  • Southfield, MI
  • NPI 1659569085
  NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567
  NPD
• Care Continuum, Inc.

  dba Heritage Care Group

  • Mental Health Counselor
  • Southfield, MI
  • NPI 1508920331
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202169600000",
    "number": "1952412322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "STE 401",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347661",
            "telephone_number": "248-358-5334",
            "fax_number": "248-356-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD",
            "address_2": "STE 401",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347661",
            "telephone_number": "248-358-5334",
            "fax_number": "248-356-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVERS",
        "first_name": "JACALYN",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802083584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "6802083584",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beaumont Kidney Specialty Services LLC
• Beaumont Medical Group- Specialty Services (Corewell Health Medical Group East)
• Beaumont Medical Group- Specialty Services (Corewell Health Medical Group East)
• Beaumont Medical Transportation Services, Inc (Beaumont Mobile Medicine)
• Sarah Elizabeth Beauregard
• Stephanie Beavis
• Bryson Beck
• Sidney B Beck, MD
• Brandi Becker-Wright
• Cristie Becker, MD

• Social Worker in Southfield, MI
• Providers in Southfield, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.