Bethel Adefres, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Porterville, CA
NPI 1376112607 · NPPES record last updated Jun 9, 2023
Key facts
- NPI
- 1376112607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 465 W Putnam Ave
Porterville, CA 93257-3320 - Phone
- (559) 784-1110
- NPI assigned
- Jun 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
Hospital & facility affiliations 2
Medicare Care Compare profile
- 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
- Yale-New Haven Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- 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 |
|---|---|---|---|---|
| I20250910000737 | CT | Order and Referring Only - Radiation Oncology |
3274036058 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80946 | CT | MD | Therapeutic Radiology Physician |
Interoperability endpoints
- badefres571349@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Therapeutic Radiology Physician | 2085R0203X | 80946 | CT | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
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
Other providers in Porterville, CA
- Tasleem Abdullah
- Zachary John Acencio
- Lareina Renee' Adams
- Lisa Adams
- Addiction Research and Treatment, Inc
- Christina C Agda
- Vinit Agrawal
- Danielle Aguilar
- Johanna Aguilar
- Juan Angel Aguilar
All providers in Porterville, CA · Student in an Organized Health Care Education/Training Program in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2023. 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.