Thomas A Bettis Jr., LSCSW
Individual provider Active NPI Clinical Social Worker · Prairie Village, KS
NPI 1194932764 · NPPES record last updated May 26, 2011
Key facts
- NPI
- 1194932764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1373 (KS)
- Practice address
- 5200 W 94TH Ter
Suite 105
Prairie Village, KS 66207-2502 - Phone
- (913) 649-5567
- Fax
- (913) 649-7563
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130925000904 | KS | Practitioner - Clinical Social Worker | 4789828088 | Practice locations: Prairie Village, KS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1373 | KS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vellore Kirubakaran M D P a | Past | Accepting new patients | |
| E Kent Stevenson MD PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1373 | KS | Yes |
Addresses
Primary practice location
5200 W 94TH Ter
Suite 105
Prairie Village, KS 66207-2502
Mailing address
5200 W 94TH Ter
Suite 105
Prairie Village, KS 66207-2502
Phone (913) 649-5567
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27178201 | Other | KS | BCBS |
Other providers in Prairie Village, KS
- Rebecca Bell
- Gilbert Benschoter
- Sarah Benshoff
- Holly Anne Benson
- James Tyler Berger
- Taylor Todd Billings
- Bim Rehab and Wellness LLC
- Birchwood Counseling Group, LLC
- Linen Biron
- Miranda Nabil Bishara
All providers in Prairie Village, KS · Clinical Social Worker in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.