Individual provider Active NPI

Betty H Altman, M.D.

  • Dentist
  • Saint Gabriel, LA
National Provider Identifier
1114145596
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3642 Issued in LA
Practice address
5760 Monticello Drive
St Gabriel, LA 70776
Phone
(225) 642-9676
Fax
(225) 642-9676
NPI assigned
Apr 23, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3642 LA Primary

Addresses

Primary practice location

5760 Monticello Drive
St Gabriel, LA 70776

Mailing address

5760 Monticello Drive
St Gabriel, LA 70776
Phone (985) 590-0443

Other identifiers 1

IdentifierTypeStateIssuer
1836427MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160219000917 LA Order and Referring Only - DentistPractitioner - Dentist 0648575274

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3642LAMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1114145596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5760 MONTICELLO DRIVE",
            "city": "ST GABRIEL",
            "state": "LA",
            "postal_code": "70776",
            "telephone_number": "985-590-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5760 MONTICELLO DRIVE",
            "city": "ST GABRIEL",
            "state": "LA",
            "postal_code": "70776",
            "telephone_number": "225-642-9676",
            "fax_number": "225-642-9676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTMAN",
        "first_name": "BETTY",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "3642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1836427",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Gabriel, LA

Sources for this page

Verify at the official NPI Registry.