Bethany Blacketer, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A69805 Issued in CA

Practice address

1330 Las Tablas Rd
Templeton, CA 93465-9758

Phone

(805) 542-6700

Fax

(805) 542-6791

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Family PracticeAlso: Obstetrics/Gynecology

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Centers of the Central Coast IncGroup PAC ID 7416868120, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Coast Home Health Inc Home health agency, San Luis Obispo, CA, CCN 059010
• Adventist Health Twin Cities Hospital, Templeton, CA, CCN 050633
• French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bethany.blacketer.1@17363.direct.athenahealth.com

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.

• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Oceano, CA
  • NPI 1336166248
  Medicare reassignment Care Compare group NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
  • NPI 1174859425
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • San Luis Obispo, CA
  • NPI 1275553257
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
  • NPI 1447277355
  NPD
• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Cambria, CA
  • NPI 1881611705
  NPD
• Dental Surgery Centers of America

  • Ambulatory Surgical Clinic/Center
  • Santa Maria, CA
  • NPI 1407130727
  NPD
• Community Health Center of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
  • NPI 1356368138
  NPD (past)
• Dignity Health

  • General Acute Care Hospital
  • Merced, CA
  • NPI 1518018191
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Coast Home Health Inc

  • Home Health Agency
  • San Luis Obispo, CA
  • NPI 1609044924
  Care Compare affiliation
• Dignity Community Care

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1881760452
  Care Compare affiliation
• Twin Cities Community Hospital, Inc.

  • General Acute Care Hospital
  • Templeton, CA
  • NPI 1396778197
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1487764833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8030",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 LAS TABLAS RD",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659758",
            "telephone_number": "805-542-6700",
            "fax_number": "805-542-6791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 Main St",
            "address_purpose": "LOCATION",
            "city": "Livingston",
            "state": "CA",
            "postal_code": "953341257",
            "country_code": "US",
            "telephone_number": "209-394-7913",
            "fax_number": "209-394-9093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKETER",
        "first_name": "BETHANY",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A69805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A698050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emily Bills, MA, OTR
• Scott E Bisheff, MD
• Erin Therese Blair, M.ED., BCBA
• John C Blaney, M.D.
• Ruth M Boisseree, NP
• Katrina Jo Bolduc, LM, CPM
• David Alfonso Bolivar, MD

• Family Medicine Physician in Templeton, CA
• Providers in Templeton, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.