Bert Ira Beverly, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

012762 Issued in ME

Practice address

258 Main St
Waterville, ME 04901-4857

Phone

(207) 873-2220

Fax

(207) 873-2221

NPI assigned

Dec 29, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2017 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1174689343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014857",
            "telephone_number": "207-873-2220",
            "fax_number": "207-873-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 MAIN ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014857",
            "telephone_number": "207-873-2220",
            "fax_number": "207-873-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVERLY",
        "first_name": "BERT",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "012762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134270000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Bennett, MD
• Kerish N Benttinen, LMSW
• Rodney G Berger, LCPC
• Carmen Alvarado Bernhardt
• Bestfit DME, Inc.
• Sapan M Bhatt, DMD
• John Taylor Bielecki, MD, MPH
• Donna Bilodeau, F.N.P.
• Melinda Bishop, RNC
• Cheryl Blaisdell

• Internal Medicine Physician in Waterville, ME
• Providers in Waterville, ME by specialty
• Internal Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.