Active NPI
Dale Anthony Bettencourt, RD
- Dietary Manager
- Sacramento, CA
National Provider Identifier
1194171645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dietary Manager
- License
- 1033537
- Practice address
- 6600 Bruceville Rd
Sacramento, CA 95823-4671 - Phone
- (916) 968-5079
- NPI assigned
- May 13, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dietary Manager | 132700000X | 1033537 | CA | Primary |
Addresses
Primary practice location
6600 Bruceville Rd
Sacramento, CA 95823-4671
Mailing address
6600 Bruceville Rd
Sacramento, CA 95823-4671
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1033537 | CA | MD | Dietary Manager |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639699200000",
"number": "1194171645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6600 BRUCEVILLE RD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958234671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 BRUCEVILLE RD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958234671",
"telephone_number": "916-968-5079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETTENCOURT",
"first_name": "DALE",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-13",
"last_updated": "2021-12-17",
"certification_date": "2021-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "132700000X",
"taxonomy_group": "",
"desc": "Dietary Manager",
"state": "CA",
"license": "1033537",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "N",
"endpointDescription": "Careqaulity",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "6600 Bruceville Rd",
"city": "Sacramento",
"state": "CA",
"country_code": "US",
"postal_code": "958234671",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Sacramento, CA
- Jenna Bethancourt, MFT
- Bethel Averbeck MD a Professional Medical Corporation
- Chloe Bethencourt
- Haley Claire Betschart
- Caitlyn Kristine Bettencourt, RN
- Haylee Bettencourt, MD
- Jeffrey Bettencourt
- Shannon Christine Bettencourt, LMFT
- Better Balance Acupuncture & Herbs Professional Corporation
- Better Decisions Counseling
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.