Individual provider Active NPI

Robert Brian Bettencourt, MD

  • Family Medicine Physician
  • Portland, OR
National Provider Identifier
1003086521
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD157616 Issued in OR
Practice address
11782 SW Barnes Rd Ste 300
Portland, OR 97225-5933
Phone
(503) 214-5200
Fax
(503) 906-6613
NPI assigned
Mar 11, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NONE AL
Family Medicine Physician 207Q00000X 29467 AL
Sports Medicine (Family Medicine) Physician 207QS0010X 29467 AL
Sports Medicine (Family Medicine) Physician 207QS0010X MD157616 OR
Family Medicine Physician 207Q00000X MD157616 OR Primary

Addresses

Primary practice location

11782 SW Barnes Rd Ste 300
Portland, OR 97225-5933

Mailing address

11782 SW Barnes Rd Ste 300
Portland, OR 97225-5933
Phone (503) 214-5200

Other practice location 1

14795 SW Murray Scholls Dr Ste 109
Beaverton, OR 97007-9230
Phone (503) 906-4301 ext. 4301

Other practice location 2

1504 Springhill Ave
Ste 1800
Mobile, AL 36604-3207
Phone (251) 434-3475

Other identifiers 2

IdentifierTypeStateIssuer
5006514641MedicaidOR
MD157616OtherOROREGON MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121227000260 OR Practitioner - Family Practice 4082749197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Fracture Clinic PCGroup PAC ID 1052219953, 56 clinicians

Practice addresses (Care Compare)

11782 SW Barnes Rd
Suite 300
Portland, OR 97225-5933
Phone (503) 214-5200

Hospital & facility affiliations

  • Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Merit-based Incentive Payment System (MIPS)

Final score
54.33 of 100Reported as group
Quality
57.12
Promoting interoperability
0
Improvement activities
30
Cost
86.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29467ALMDFamily Medicine Physician
NONEALMDFamily Medicine Physician
MD157616ORMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic & Fracture Clinic PC CurrentSince Dec 1, 2018 Accepting new patients
Orthopedic & Fracture Clinic PC CurrentSince Dec 1, 2018 Accepting new patients

Locations

14795 SW Murray Scholls Dr
Ste 109
Beaverton, OR 97007
Phone 5039064301 ext. 4301

11782 SW Barnes Rd
Ste 300
Portland, OR 97225
Phone (503) 214-5200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1003086521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11782 SW BARNES RD STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255933",
            "telephone_number": "503-214-5200",
            "fax_number": "503-906-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11782 SW BARNES RD STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255933",
            "telephone_number": "503-214-5200",
            "fax_number": "503-906-6613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14795 SW Murray Scholls Dr Ste 109",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970079230",
            "country_code": "US",
            "telephone_number": "503-906-4301 x4301",
            "fax_number": "503-906-6613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1504 Springhill Ave",
            "address_2": "Ste 1800",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366043207",
            "country_code": "US",
            "telephone_number": "251-434-3475",
            "fax_number": "251-434-3837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BETTENCOURT",
        "first_name": "ROBERT",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-11",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "NONE",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "29467",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AL",
            "license": "29467",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "OR",
            "license": "MD157616",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD157616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5006514641",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON MEDICAL LICENSE",
            "identifier": "MD157616",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.