BEAVERTOWN CLINIC INC
NPI 1902803703
Family Medicine in Kettering, OH

Q: What is Beavertown Clinic Inc's NPI number?

The NPI number for Beavertown Clinic Inc is 1902803703. It was assigned to this organization in the NPPES registry on July 7, 2005.

Q: What is Beavertown Clinic Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since July 07, 2005CLIA 36D0349842 · Microscopy

3017 WILMINGTON PIKE, KETTERING, OH 45429(937) 294-2555(937) 294-3211 Get Directions Write a Review

NPPES record last updated: February 23, 2010. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Beavertown Clinic Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEAVERTOWN CLINIC INC (NPI 1902803703) is a healthcare organization registered as a family medicine in Kettering, Ohio and active in the NPI registry since July 2005. The organization holds a CLIA Microscopy certificate valid through August 31, 2028 and lists Bernard J Rose, Physician, as its authorized official.

NPPES Registry Identity

NPI1902803703

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameBEAVERTOWN CLINIC INC

Location Address3017 WILMINGTON PIKEKettering, OH 45429-4169

Mailing Address3017 Wilmington PikeKettering, OH 45429-4169 · (937) 294-2555 · Fax (937) 294-3211

Phone(937) 294-2555

Fax(937) 294-3211

Organization SubpartNo

Authorized OfficialBernard J RosePhysician · (937) 294-2555

Enumeration DateJuly 7, 2005

Last NPPES UpdateFebruary 23, 2010

✔ NPI 1902803703 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in OH · 35052219R✔ Licensed in OH · 35058825R

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

3017 WILMINGTON PIKE, Kettering, OH 45429

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Other Identifiers 5

Medicare UPINA17231OH

Medicare ID-Type UnspecifiedR00698961OH · Dr K Rose Individual Pi

MedicaidR00609981OH

Medicare UPINE97912OH

Medicare ID-Type UnspecifiedBE9266611OH · Group Id

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Beavertown Clinic Inc 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 Beavertown Clinic Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Bernard Rose, M.D.

General Practice

NPI 1508864042

3017 WILMINGTON PIKE
Kettering, OH 45429

(937) 294-2555

✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 36D0349842

Beavertown Clinic Inc · Dayton, OH

Active · expires Aug 31, 2028

CLIA Number36D0349842

Laboratory TypePhysician Office

Certificate Effective DateSeptember 1, 2026

Certificate Expiration DateAugust 31, 2028

Laboratory DirectorKarl G. Rose

Laboratory Phone(937) 294-2555

Laboratory LocationBeavertown Clinic Inc3017 Wilmington Pike, Dayton, OH 45429

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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 Beavertown Clinic Inc's NPI number?

The NPI number for Beavertown Clinic Inc is 1902803703. It was assigned to this organization in the NPPES registry on July 7, 2005.

Where is Beavertown Clinic Inc located?

Beavertown Clinic Inc is located at 3017 Wilmington Pike, Kettering, OH 45429. The listed phone number is (937) 294-2555.

What is Beavertown Clinic Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Beavertown Clinic Inc enrolled in Medicare?

Yes. Beavertown Clinic Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Beavertown Clinic Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Beavertown Clinic Inc. 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.

Does Beavertown Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 36D0349842) is associated with this NPI, valid through August 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Beavertown Clinic Inc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Beavertown Clinic Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Beavertown Clinic Inc was last updated on February 23, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.