Wesley Shane Bethea, D.C.
Individual provider Active NPI Chiropractor · Perry, FL
NPI 1376613844 · NPPES record last updated Jul 16, 2007
Key facts
- NPI
- 1376613844
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH 9250 (FL)
- Practice address
- 100 Plantation Rd
Suite a
Perry, FL 32348-6000 - Phone
- (850) 584-6006
- Fax
- (850) 584-6001
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Life Chiropractic College, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Coastal Complete Care, PA
Practice addresses (Care Compare)
100 Plantation Rd
Perry, FL 32348-6000
Phone (850) 584-6000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080621000004 | FL | Practitioner - Chiropractic | 8820037336 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006977 | GA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Complete Care, PA | Chiropractor | Current |
Accepting new patients |
| Americus Injury and Wellness Center | Chiropractor | Past |
Accepting new patients |
Locations
100 Plantation Rd
Ste A
Perry, FL 32348
Phone (850) 584-6000
100 Plantation Rd
Perry, FL 32348
Phone (850) 584-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 006977 | GA | |
| Chiropractor | 111N00000X | CH 9250 | FL | Yes |
Addresses
Primary practice location
100 Plantation Rd
Suite a
Perry, FL 32348-6000
Mailing address
100 Plantation Rd
Suite a
Perry, FL 32348-6000
Phone (850) 584-6006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 76997 | Other | FL | BLUE CROSS BLUE SHIELD OF |
Other providers in Perry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2007. 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.
- 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.