Active NPI
Beth Mack Gentner, P.A.-C
- Physician Assistant
- Fenton, MI
National Provider Identifier
1457328833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601002066
- Practice address
- 102 N Adelaide St
Fenton, MI 48430-2670 - Phone
- (810) 629-2245
- Fax
- (810) 629-6535
- NPI assigned
- Mar 3, 2006
- 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 | 5601002066 | MI | Primary |
Addresses
Primary practice location
102 N Adelaide St
Fenton, MI 48430-2670
Mailing address
5163 E Holly Rd
Holly, MI 48442-9746
Phone (248) 634-8840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MM0921735 | Other | MI | MEDICARE RR ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Fenton, MI
- NPI 1134165632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1457328833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5163 E HOLLY RD",
"city": "HOLLY",
"state": "MI",
"postal_code": "484429746",
"telephone_number": "248-634-8840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 N ADELAIDE ST",
"city": "FENTON",
"state": "MI",
"postal_code": "484302670",
"telephone_number": "810-629-2245",
"fax_number": "810-629-6535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTNER",
"first_name": "BETH",
"middle_name": "MACK",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-03",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601002066",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR ID",
"identifier": "MM0921735",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.