Active NPI
Bethany J. Desimone, ATC
- Sports Medicine (Preventive Medicine) Physician
- Bellevue, WA
National Provider Identifier
1306136643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- A1 60045357
- Practice address
- 1750 112TH Ave NE Ste D154
Bellevue, WA 98004-3727 - Phone
- (425) 643-9778
- Fax
- (425) 643-6448
- NPI assigned
- Apr 7, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | A1 60045357 | WA | Primary |
Addresses
Primary practice location
1750 112TH Ave NE Ste D154
Bellevue, WA 98004-3727
Mailing address
1750 112TH Ave NE Ste D154
Bellevue, WA 98004-3727
Phone (425) 643-9778
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 |
|---|---|---|---|
| A1 60045357 | WA | MD | Sports Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302134400000",
"number": "1306136643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 112TH AVE NE STE D154",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980043727",
"telephone_number": "425-643-9778",
"fax_number": "425-643-6448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 112TH AVE NE STE D154",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980043727",
"telephone_number": "425-643-9778",
"fax_number": "425-643-6448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESIMONE",
"first_name": "BETHANY",
"middle_name": "J.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-07",
"last_updated": "2011-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "WA",
"license": "A1 60045357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.