Bertram Clifford Providence, M.D.

Primary specialty

Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X

License

MD-11256 Issued in HI

Practice address

459 Patterson Rd
Honolulu, HI 96819-1522

Phone

(808) 433-0600

NPI assigned

Oct 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1174512057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 PATTERSON RD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968191522",
            "telephone_number": "808-433-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 PATTERSON RD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968191522",
            "telephone_number": "808-433-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Jarrett White Road",
            "address_purpose": "LOCATION",
            "city": "TAMC",
            "state": "HI",
            "postal_code": "96819",
            "country_code": "US",
            "telephone_number": "808-433-5551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVIDENCE",
        "first_name": "BERTRAM",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "HI",
            "license": "MD-11256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prosthetic & Orthotic Associates of Hawaii
• Brooke Michi Protacio
• Renato Quinto Protacio
• Protea Counseling LLC
• Providence Living LLC
• Chattip Prueksapraopong, MD
• Jacob Andrew Prussman
• PSH Oahu LLC
• Psyche, Inc.
• Psychiaric Services

• Adult Reconstructive Orthopaedic Surgery Physician in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Adult Reconstructive Orthopaedic Surgery Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.