Bethany Anne Musallam, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704244961 Issued in MI

Practice address

15125 22 Mile Rd.
Shelby Pediatrics
Shelby Township, MI 48315

Phone

(586) 532-0599

Fax

(586) 566-8967

NPI assigned

Jan 29, 2008

Last updated

Jul 29, 2022By 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 2

Addresses

Other names 1

• Bethany Anne Haver Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmusallam1458319@epic00.shdirect.org

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.

• Beaumont Medical Group Hospital -Based Services

  • Hospitalist Physician
  • Royal Oak, MI
  • NPI 1427567858
  Medicare reassignment NPD
• DMC Orthopedic Billing Associates LLC

  dba DMC Billing Associates, LLC

  • Orthopaedic Surgery Physician
  • Detroit, MI
  • NPI 1457387607
  NPD (past)
• Shelby Pediatric Associates and Child Lung Center PC

  • Pediatrics Physician
  • Shelby Township, MI
  • NPI 1124051990
  NPD (past)

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

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1295912624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD.",
            "address_2": "SHELBY PEDIATRICS",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "48315",
            "telephone_number": "586-532-0599",
            "fax_number": "586-566-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD.",
            "address_2": "SHELBY PEDIATRICS",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "48315",
            "telephone_number": "586-532-0599",
            "fax_number": "586-566-8967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44201 Dequindre Rd Ste Ec",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480851117",
            "country_code": "US",
            "telephone_number": "248-964-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUSALLAM",
        "first_name": "BETHANY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-29",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704244961",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704244961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bmusallam438498@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "44201 Dequindre Rd Ste Ec",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480851117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "HAVER",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paulina Multhaupt
• Christina A Munn, P.A.
• Kathleen Murphy, MA, LLPC, NCC
• Jennika Ann Murray, DPT
• Kevin P Murrell, DDS
• Andy Musgrove
• Muslim Spiritual Care and Hospice Network
• Mariana Alicia Myers
• Myeyedr Optometry of Michigan, LLC (MyEyeDr.)
• Jordan E Nacker

• Pediatric Nurse Practitioner in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.