Physician Compare National (NPI:1104921782)

HEALTHCARE PROVIDER: NOLAN JACKSON BEAVERS M.D,

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104921782
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143213637
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040408000689
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BEAVERS
	Individual professional last name
Provider First Name	NOLAN
	Individual professional first name
Provider Middle Name	JACKSON
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2337 G ST
	Group Practice or individual's line 1 address
City	BELLEVILLE
	Group Practice or individual's city
State	KS
	Group Practice or individual's state
Zip Code	669352463
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7855272217
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	171361
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	REPUBLIC COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	171309
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	JEWELL COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	171349
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CLOUD COUNTY HEALTH CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	281315
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	BRODSTONE MEMORIAL HOSP
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	171375
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1104921782)

HEALTHCARE PROVIDER: NOLAN JACKSON BEAVERS M.D,

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information