Genevieve E Bertram – Behavior Technician

Key facts

NPI: 1104423540
Entity type: Individual (NPI type 1)
Primary specialty: Behavior Technician 106S00000X
Practice address: 1555 SE Delaware Ave Ste O
Ankeny, IA 50021-4011
Phone: (515) 261-2402
NPI assigned: Oct 8, 2020
Sex: Female
Sole proprietor: No

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.

KP Enterprises Iowa Multi-Specialty Clinic/Center · Ankeny, IA · NPI 1518478684

NPD (past)
KP Enterprises Iowa Behavior Analyst · Ankeny, IA · NPI 1659881035

NPD (past) BEHAVIOR TECHNICIAN

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
KP Enterprises Iowa	Behavior Technician	Past since Oct 11, 2020	Accepting new patients
KP Enterprises Iowa		Past since Oct 11, 2020	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Behavior Technician	106S00000X			Yes

Addresses

Primary practice location

1555 SE Delaware Ave Ste O
Ankeny, IA 50021-4011

Mailing address

510 Billy Sunday Rd Unit 101
Ames, IA 50010-8113
Phone (641) 251-4343

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 8, 2020.

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1104423540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 BILLY SUNDAY RD UNIT 101",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500108113",
            "telephone_number": "641-251-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SE DELAWARE AVE STE O",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500214011",
            "telephone_number": "515-261-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "GENEVIEVE",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

All providers in Ankeny, IA · Behavior Technician in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.