Individual provider Active NPI

Betty Siu, MD

  • Internal Medicine Physician
  • Waldorf, MD
National Provider Identifier
1073609038
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0062287 Issued in MD
Practice address
3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233
Phone
(301) 609-5200
Fax
(301) 609-5220
NPI assigned
Oct 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0062287 MD Primary

Addresses

Primary practice location

3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233

Mailing address

3510 Old Washington Rd
Suite #100
Waldorf, MD 20602-3233
Phone (301) 609-5200

Other identifiers 1

IdentifierTypeStateIssuer
D0062287OtherMDLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050323001309 MD Practitioner - Internal Medicine 8022064930 Reassigns benefits to 4 organizations
I20150310001787 DC Practitioner - Internal Medicine 8022064930 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Howard University College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cook and Siu PCGroup PAC ID 6406997550, 2 clinicians

Practice addresses (Care Compare)

3450 Old Washington Rd
Suite 103
Waldorf, MD 20602-3249
Phone (301) 472-4290

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0062287MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Internal Medicine CurrentSince Jan 29, 2015 Accepting new patients
Menocal Medical Services PA Current Accepting new patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 3, 2018 Accepting new patients
Privia Care Center LLC Internal Medicine CurrentSince Oct 3, 2018 Accepting new patients
Civista Medical Center, Inc. CurrentSince Jan 1, 2005 Accepting new patients
Privia Medical Group, LLC CurrentSince Jan 29, 2015 Accepting new patients
Civista Medical Center Inc CurrentSince Jan 1, 2005 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

133 Defense Hwy
Ste 112
Annapolis, MD 21401
Phone (410) 573-0140

301 Saint Paul St
Ste 409
Baltimore, MD 21202
Phone (410) 659-7041

110 Baughmans Ln
Ste 140
Frederick, MD 21702
Phone (240) 215-1138

701 Charles St
La Plata, MD 20646
Phone (301) 609-4000

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

11350 Pembrooke Sq
Ste 304
Waldorf, MD 20603
Phone (301) 856-2810

3450 Old Washington Rd
Ste 103
Waldorf, MD 20602
Phone (301) 472-4290

3510 Old Washington Rd
Ste 100
Waldorf, MD 20602
Phone (301) 609-5200

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

Interoperability endpoints

  • Direct secure messaging: betty.siu.1@20527.direct.athenahealth.com

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073609038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 OLD WASHINGTON RD",
            "address_2": "SUITE #100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023233",
            "telephone_number": "301-609-5200",
            "fax_number": "301-609-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 OLD WASHINGTON RD",
            "address_2": "SUITE #100",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023233",
            "telephone_number": "301-609-5200",
            "fax_number": "301-609-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIU",
        "first_name": "BETTY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0062287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "D0062287",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.