A LIFE RENEWED
NPI 1780460006
Nurse Practitioner - Psychiatric/Mental Health in Centerville, OH
About A Life Renewed NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
A LIFE RENEWED (NPI 1780460006) is a healthcare organization registered as a psychiatric/mental health in Centerville, Ohio and active in the NPI registry since September 2023. The organization lists Brad Gibson, Ceo/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
A Life Renewed is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to A Life Renewed, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Beacon St. Psychiatry's NPI number?
The NPI number for Beacon St. Psychiatry is 1780460006. It was assigned to this organization in the NPPES registry on September 1, 2023. The provider is doing business as A Life Renewed.
Where is Beacon St. Psychiatry located?
Beacon St. Psychiatry is located at 10552 Success Ln Ste L, Centerville, OH 45458. The listed phone number is (937) 280-5711.
What is Beacon St. Psychiatry's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Beacon St. Psychiatry enrolled in Medicare?
Yes. Beacon St. Psychiatry is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Beacon St. Psychiatry?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Beacon St. Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Beacon St. Psychiatry was last updated on January 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# A Life Renewed · NPI 1780460006
Psychiatric/Mental Health organization in Centerville, Ohio. Organization record, active in the CMS NPPES registry since September 1, 2023.
## Identity
- **NPI:** 1780460006 (Entity type: Organization)
- **Enumerated:** September 1, 2023
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Legal business name:** Beacon St. Psychiatry
- **Organization subpart:** No
- **Authorized official:** Brad Gibson, CEO/OWNER
## Practice location
- **Address:** 10552 SUCCESS LN STE L, Centerville, OH 45458-3664
- **Phone:** (937) 280-5711
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 24, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1780460006) · Data from the CMS NPPES public registry.