Beacon St. Psychiatry
NPI 1780460006 · Psychiatric/Mental Health Nurse Practitioner · Centerville, OH
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Beacon St. Psychiatry is a Psychiatric/Mental Health Nurse Practitioner organization in Centerville, OH (NPI 1780460006).
Provider details
- NPI number
- 1780460006
- Entity type
- Organization
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Brad Gibson, Ceo/Owner(937) 280-5711
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- A Life Renewed
- Doing business as
- A Life Renewed
Registry dates
- Enumerated
- 2023-09-01
- Last updated
- 2024-01-24
- Certified
- 2024-01-24
Frequently asked questions
- What is Beacon St. Psychiatry's NPI number?
- Beacon St. Psychiatry's National Provider Identifier (NPI) is 1780460006, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Beacon St. Psychiatry?
- Beacon St. Psychiatry is classified in the NPPES registry as Psychiatric/Mental Health Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers).
- Where is Beacon St. Psychiatry located?
- Beacon St. Psychiatry's practice location on file with NPPES is 10552 Success Ln Ste L, Centerville, OH 45458-3664.
- What is Beacon St. Psychiatry's phone number?
- The practice phone number listed in the NPPES registry for Beacon St. Psychiatry is (937) 280-5711.
- Does Beacon St. Psychiatry accept Medicare?
- Beacon St. Psychiatry is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Beacon St. Psychiatry?
- The authorized official listed on Beacon St. Psychiatry's NPPES record is Brad Gibson, Ceo/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Beacon St. Psychiatry's NPI active?
- Yes — Beacon St. Psychiatry's NPI (1780460006) is active in the NPPES registry as of the last update on 2024-01-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.