Individual provider Active NPI

Maurice Bettez, M.D.

  • Otolaryngology Physician
  • Potsdam, NY
National Provider Identifier
1376623140
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
151878-1 Issued in NY
Practice address
50 Leroy St
Potsdam, NY 13676-1786
Phone
(315) 265-3300
NPI assigned
Oct 16, 2006
Last updated
Mar 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 151878-1 NY Primary

Addresses

Primary practice location

50 Leroy St
Potsdam, NY 13676-1786

Mailing address

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Other identifiers 1

IdentifierTypeStateIssuer
01703740MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20080721000425 NY Practitioner - Otolaryngology 3375616618 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
151878-1NYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Jul 5, 2016 Accepting new patients
Canton-Potsdam Hospital CurrentSince Jul 5, 2016 Accepting new patients

Locations

190 Outer Main St
Potsdam, NY 13676
Phone (315) 265-1095

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1376623140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-265-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-265-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTEZ",
        "first_name": "MAURICE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "151878-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01703740",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Potsdam, NY

Sources for this page

Verify at the official NPI Registry.