Provider Demographics
NPI:1528080686
Name:BEAUCHAMP, GARY D (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2411
Mailing Address - Country:US
Mailing Address - Phone:816-584-8884
Mailing Address - Fax:913-588-9220
Practice Address - Street 1:1530 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-7129
Practice Address - Country:US
Practice Address - Phone:816-781-1696
Practice Address - Fax:816-781-5438
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5969207RC0000X
KS04-14844207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
225043OtherHEALTHLINK-NCPPO
4001285OtherMO & KS / AETNA PPO & HMO
557640OtherFAMILY HEALTH PARTNERS
151824XXOtherPREFERRED CARE NY
504290OtherFIRST GUARD HLTH PLAN
10001216901OtherCOMMUNITY HLTH PLAN OF MO
KS100202570AMedicaid
KS051563OtherBCBS KS OUTREACH CLINICS
04472015OtherBCBS KC
MO200019503Medicaid
KS100202570BMedicaid
MO0383364AMedicare PIN
KS110330010Medicare PIN
MO038E00018Medicare PIN
MO0383364EMedicare PIN
KS0383364BMedicare PIN
557640OtherFAMILY HEALTH PARTNERS
4001285OtherMO & KS / AETNA PPO & HMO
KS060062374Medicare PIN