Bethany Joel Derhodes, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

35.088279 Issued in OH

Practice address

2222 Philadelphia Dr
Suite 4505
Dayton, OH 45406-1813

Phone

(937) 734-4363

Fax

(937) 734-4181

NPI assigned

Sep 13, 2006

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bethany Joel Stockholm Former name

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Heart Associates, Inc

  • Cardiovascular Disease Physician
  • Beavercreek, OH
  • NPI 1538188735
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174627681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 MORGAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452062348",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 PHILADELPHIA DR",
            "address_2": "SUITE 4505",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454061813",
            "telephone_number": "937-734-4363",
            "fax_number": "937-734-4181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "446 Morgan St",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452062348",
            "country_code": "US",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Wyoming St Ste 3115",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092722",
            "country_code": "US",
            "telephone_number": "937-208-2901",
            "fax_number": "937-208-2911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450052584",
            "country_code": "US",
            "telephone_number": "513-424-2111",
            "fax_number": "513-420-5247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERHODES",
        "first_name": "BETHANY",
        "middle_name": "JOEL",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35.088279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0064055",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "STOCKHOLM",
            "middle_name": "JOEL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Department of Veterans Affairs
• Dependable Care Traveling NP LLC
• Kent Andrew Depue, MD
• Leyla Dereci, DO
• Carly Anne Deremo, PSYD
• Byron K Derksen, LPN
• James A. Derksen, MD
• Dermatologists of Southwestern Ohio, LLC. (Dermatologists of Southwest Ohio, LLC)
• Dermatology Associates of Ohio, LLC
• Dermatopathology Laboratory of Central States

• Psychiatry Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Psychiatry Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.