Elizabeth Obber Bettencourt, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Melrose, MA
NPI 1366436974 · NPPES record last updated Jun 16, 2008
Key facts
- NPI
- 1366436974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 207705 (MA)
- Practice address
- 50 Rowe St
Suite 400
Melrose, MA 02176-3201 - Phone
- (781) 665-6606
- Fax
- (781) 665-1277
- NPI assigned
- Sep 9, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Uniformed Services Uhs Fe Hebert School of Med, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hallmark Health Medical Associates Inc
Practice addresses (Care Compare)
425 Revere St
Revere, MA 02151-4543
Phone (781) 665-6606
585 Lebanon St
Melrose, MA 02176-3225
Phone (781) 979-3000
Hospital & facility affiliations
- Melrosewakefield Healthcare
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080609000765 | MA | Practitioner - Obstetrics/Gynecology | 7517037112 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 207705 | MA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hallmark Health Medical Associates Inc | Obstetrics & Gynecology | Current |
Accepting new patients |
| Melrosewakefield Healthcare, Inc. | Past | Accepting new patients |
Locations
50 Rowe St
Melrose, MA 02176
Phone (781) 620-4944
50 Rowe St
Ste 400
Melrose, MA 02176
Phone (781) 665-6605
425 Revere St
Revere, MA 02151
Phone (781) 286-1313
Interoperability endpoints
- ebettencourt23925@tuftsmedicine.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 207705 | MA | Yes |
Addresses
Primary practice location
50 Rowe St
Suite 400
Melrose, MA 02176-3201
Mailing address
50 Rowe Street
Suite 400
Melrose, MA 02176
Phone (781) 665-6606
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0167291 | Medicaid | MA |
Other providers in Melrose, MA
- Elijah Berg
- Jack F Berg
- Evan R Berman
- Emma Best
- Beth B Schmitt Licsw LLC
- Nehaben Gopalbhai Bhavsar
- Marcia M. Binder
- Samantha Block
- Sarah Bloom
- Julie Ann Blume Oeur
All providers in Melrose, MA · Obstetrics & Gynecology Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2008. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.