Individual provider Active NPI

Bethany Briggs, D.O.

  • Surgery Physician
  • Champaign, IL
National Provider Identifier
1407202450
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036167517 Issued in IL
Practice address
3105 Fields South Dr
Champaign, IL 61822-3743
Phone
(217) 383-3240
NPI assigned
May 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X H0094653 MD
Surgery Physician 208600000X 036167517 IL Primary

Addresses

Primary practice location

3105 Fields South Dr
Champaign, IL 61822-3743

Mailing address

611 W Park St
Fapc
Urbana, IL 61801-2500

Other practice location 1

345 Saint Paul St
Baltimore, MD 21202-2123
Phone (410) 332-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20231218000234 IL Practitioner - General Surgery 3971986613 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

3103 Fields S Dr
Champaign, IL 61822-3743
Phone (217) 902-2300

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036167517ILMDSurgery Physician
H0094653MDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle West Physician Group Inc CurrentSince Dec 7, 2023 Accepting new patients
Carle Health Care Incorporated CurrentSince Dec 7, 2023 Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

3105 Fields South Dr
Champaign, IL 61822
Phone (217) 902-3277

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: bbriggsdo395090@carlehiedirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1407202450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 FIELDS SOUTH DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618223743",
            "telephone_number": "217-383-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Saint Paul St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212022123",
            "country_code": "US",
            "telephone_number": "410-332-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRIGGS",
        "first_name": "BETHANY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-09",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MD",
            "license": "H0094653",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036167517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.