Active NPI
Bethany Haubert Regner, PA
- Physician Assistant
- Southfield, MI
National Provider Identifier
1407048275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601004534
- Practice address
- 16001 W 9 Mile Rd
Southfield, MI 48075-4818 - Phone
- (248) 849-5806
- Fax
- (248) 849-5489
- NPI assigned
- Aug 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601004534 | MI | Primary |
Addresses
Primary practice location
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Mailing address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-5806
Other practice location 1
1200 E Michigan Ave
Ste 550
Lansing, MI 48912
Phone (517) 484-4520
Other practice location 2
47601 Grand River Ave
Novi, MI 48374-1233
Phone (248) 465-4311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601004534 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649289600000",
"number": "1407048275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16001 W 9 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754818",
"telephone_number": "248-849-5806",
"fax_number": "248-849-5489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16001 W 9 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754818",
"telephone_number": "248-849-5806",
"fax_number": "248-849-5489"
}
],
"practiceLocations": [
{
"address_1": "1200 E Michigan Ave",
"address_2": "Ste 550",
"address_purpose": "LOCATION",
"city": "Lansing",
"state": "MI",
"postal_code": "48912",
"country_code": "US",
"telephone_number": "517-484-4520",
"fax_number": "517-484-3930",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "47601 Grand River Ave",
"address_purpose": "LOCATION",
"city": "Novi",
"state": "MI",
"postal_code": "483741233",
"country_code": "US",
"telephone_number": "248-465-4311",
"fax_number": "248-465-4651",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REGNER",
"first_name": "BETHANY",
"middle_name": "HAUBERT",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-15",
"last_updated": "2022-04-07",
"certification_date": "2022-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601004534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.