Individual provider Active NPI

Bethany Gillman

  • Nurse Practitioner
  • Panama City, FL
National Provider Identifier
1356709588
Registry record updated Jun 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP9287624 Issued in FL
Practice address
2195 Jenks Ave
Panama City, FL 32405-4682
Phone
(850) 784-6696
NPI assigned
Feb 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP9287624 FL Primary

Addresses

Primary practice location

2195 Jenks Ave
Panama City, FL 32405-4682

Mailing address

633 E Baldwin Rd
Panama City, FL 32405-4207
Phone (850) 784-6696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160622000174 FL Practitioner - Nurse Practitioner 5991096943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Institute of Endocrinology Diabetes Health and HormonesGroup PAC ID 8729300454, 32 clinicians

Practice addresses (Care Compare)

633 E Baldwin Rd
Panama City, FL 32405-4207
Phone (850) 522-5490

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9287624FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Institute of Endocrinology Diabetes Health and Hormones CurrentSince Jul 1, 2018 Accepting new patients
Azzam Adhal, M.D. PastSince Apr 16, 2016 Accepting new patients

Locations

1241 Airport Rd
Ste M
Destin, FL 32541
Phone (850) 460-7090

633 E Baldwin Rd
Panama City, FL 32405
Phone (850) 522-5490

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1356709588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 E BALDWIN RD",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054207",
            "telephone_number": "850-784-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054682",
            "telephone_number": "850-784-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLMAN",
        "first_name": "BETHANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-02",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9287624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.