Individual provider Active NPI

Beth J Dubois, D.C.

  • Orthopedic Chiropractor
  • Oswego, NY
National Provider Identifier
1073604450
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
X009932-1 Issued in NY
Practice address
55 E Bridge St
Oswego, NY 13126-2120
Phone
(315) 342-6300
Fax
(315) 342-6302
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Chiropractor 111NX0800X X009932-1 NY Primary

Addresses

Primary practice location

55 E Bridge St
Oswego, NY 13126-2120

Mailing address

55 E Bridge St
Oswego, NY 13126-2120
Phone (315) 342-6300

Other identifiers 2

IdentifierTypeStateIssuer
X009932-1OtherNYLIC NUMBER
C09932-7BOtherNYWORKERS COMPENSATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050831000498 NY Practitioner - Chiropractic 2860424793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anthony V. Licatese , DC, P.C.Group PAC ID 0446344113, 2 clinicians

Practice addresses (Care Compare)

55 E Bridge St
Oswego, NY 13126-2120
Phone (315) 342-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X009932-1NYMDOrthopedic Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Anthony V. Licatese , DC, P.C. CurrentSince Jun 6, 2014 Accepting new patients
Falanga Family Chiropractic P.C. Past Accepting new patients
Tara Chiropractic Care Center, LLC Past Accepting new patients
Southside Medical & Physical Therapy, LLC Past Accepting new patients

Locations

55 E Bridge St
Oswego, NY 13126
Phone (315) 342-6300

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1073604450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E BRIDGE ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131262120",
            "telephone_number": "315-342-6300",
            "fax_number": "315-342-6302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E BRIDGE ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131262120",
            "telephone_number": "315-342-6300",
            "fax_number": "315-342-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOIS",
        "first_name": "BETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "NY",
            "license": "X009932-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "X009932-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "C09932-7B",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.