GREGORY ROYCE BEAVERS (NPI# 1245465137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245465137 |
| Entity Type | Individual |
| Full Name | GREGORY ROYCE BEAVERS |
| Credential | IDMT |
| Practice Address |
2501 Capehart Rd Offutt A F B NE 68113-1043 |
| Practice Telephone | 4022949429 |
| Practice Fax Number | 4022321644 |
| Mailing Telephone | 4022949429 |
| Mailing Fax Number | 4022321644 |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2009-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
2501 CAPEHART RD |
| City | OFFUTT A F B |
| State | NE |
| Zip Code | 68113-1043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841562212 | Kendra Lynn Haynes | Dental Hygienist | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2012-02-01 |
| 1275816902 | Jeremy Lee Hurst | Nurse Practitioner | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2011-09-20 |
| 1568758746 | Daniel Joseph Binkowski | Dentist | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2011-06-25 |
| 1427355866 | Andrea Jefferson | Military Health Care Provider | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2011-02-22 |
| 1447553169 | Jeffrey Grant Larkin | Dentist | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2010-12-20 |
| 1629309109 | Miriam E Flack | Dietitian, Registered | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2010-01-22 |
| 1194954412 | Molly Claire Goessling | Pharmacist | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2009-07-08 |
| 1447486253 | Aaron Michael Wulff | Dentist | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2009-06-08 |
| 1407082522 | Claude Alan Russo | Military Health Care Provider | 2501 Capehart Rd, Sgopf, Offutt A F B, NE 68113-1043 | 2009-06-03 |
| 1619111895 | Jacquelene Sheree Cota | Military Health Care Provider | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2009-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386133668 | Peter Mitchell Martin | Family Medicine | Offutt Afb Family Medicine Residency, 2501 Capehart Rd., Offutt Afb, NE 68113 | 2018-05-02 |
| 1619212792 | Tyrone Antonio Simon | Social Worker | 2501 Capehart Rd Bldg 4000, Offutt Afb, NE 68113 | 2012-11-30 |
| 1245536994 | Aaron Bradley Smith | Military Health Care Provider | Ehrling Bergquist Clinic, 2501 Capehart Rd, Offutt Afb, NE 68113 | 2011-01-28 |
| 1962719294 | Amy Elaine Klein | Optometrist | 106 Meyer Ave, Bldg 166, Offutt Afb, NE 68113 | 2010-09-08 |
| 1720248974 | Americas Best Contacts & Eyeglasses | Technician/Technologist | Bldg 166 Offutt Afb Exchange, Offutt Afb, NE 68113 | 2008-06-11 |
| 1548343296 | Jack David Wright | Pharmacist | 2501 Capehart, Erhling Bergquist Hospital, Offutt Afb, NE 68113 | 2006-10-23 |
| 1215023890 | Mark James Angerbauer | Dentist | 2501 Capehart Rd., Omaha, NE 68113 | 2006-10-04 |
| 1003915430 | 55th Medical Group Sgsl | Pharmacy | Bldg 107 Rm 101, Offutt, NE 68113 | 2006-09-22 |
| 1407804800 | Valerie June Malloy | Family Medicine | Offutt Afb, Erhling Berquist Clinic, Belluvue, NE 68113 | 2006-05-05 |
| 1457766909 | Robyn Thiede | Nurse Practitioner | 2501 Capehart Road, Family Medicine Residency Clinic, Ehrling Bergquist, Offutt Afb, NE 68113 | 2014-06-24 |
| Find all providers in zip 68113 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235402165 | Rachel Belden | Military Health Care Provider | 105 Grant Cir Ste 133, Offutt A F B, NE 68113-4041 | 2012-02-23 |
| 1427355866 | Andrea Jefferson | Military Health Care Provider | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2011-02-22 |
| 1255561973 | Karolyn A Harris | Military Health Care Provider | 105 Grant Cir, Ste 133, Offutt A F B, NE 68113-2087 | 2009-07-15 |
| 1669608774 | Charles Curtis Ruggles | Military Health Care Provider | 105 Grant Cir, Bldg 527, Suite 133, Offutt A F B, NE 68113-4041 | 2009-06-03 |
| 1407082522 | Claude Alan Russo | Military Health Care Provider | 2501 Capehart Rd, Sgopf, Offutt A F B, NE 68113-1043 | 2009-06-03 |
| 1508091505 | Jan Fink | Military Health Care Provider | 105 Grant Cir, Bldg 527 Suite 133, Offutt A F B, NE 68113-4041 | 2009-05-19 |
| 1942434352 | Richelle Leigh Moen | Military Health Care Provider | 105 Grant Cir, Suite 133, Offutt A F B, NE 68113-4041 | 2009-05-13 |
| 1619111895 | Jacquelene Sheree Cota | Military Health Care Provider | 2501 Capehart Rd, Offutt A F B, NE 68113-1043 | 2009-05-01 |
| 1043453129 | Jessica S Eby | Military Health Care Provider | 2501 Capehart Rd, Flight Medicine, Offutt A F B, NE 68113-1043 | 2009-04-20 |
| 1659514057 | Joey Depositar Torres | Military Health Care Provider | 105 Grant Cir, Building 527, Suite 133, Offutt A F B, NE 68113-4041 | 2009-04-14 |
| Find all providers in OFFUTT A F B | ||||
| City | OFFUTT A F B |
| Zip Code | 68113 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.