Individual provider Active NPI

Bethel Adefres, MD

  • Student in an Organized Health Care Education/Training Program
  • Porterville, CA
National Provider Identifier
1376112607
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
465 W Putnam Ave
Porterville, CA 93257-3320
Phone
(559) 784-1110
NPI assigned
Jun 21, 2021
Last updated
Jun 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Therapeutic Radiology Physician 2085R0203X 80946 CT
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

465 W Putnam Ave
Porterville, CA 93257-3320

Mailing address

20 York St
New Haven, CT 06510-3220
Phone (203) 200-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250910000737 CT Order and Referring Only - Radiation OncologyPractitioner - Radiation Oncology 3274036058

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of California, Geffen School of Medicine, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

600 Ivy St
Suite 206
Elmira, NY 14905-1627

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
80946CTMDTherapeutic Radiology Physician

Interoperability endpoints

  • Direct secure messaging: badefres571349@direct.ynhh.org

Hospital & facility affiliations 2

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": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1376112607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-200-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 W PUTNAM AVE",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932573320",
            "telephone_number": "559-784-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEFRES",
        "first_name": "BETHEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "CT",
            "license": "80946",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Porterville, CA

Sources for this page

Verify at the official NPI Registry.