NPIMap

Individual provider Active NPI

Cyril VK Bethala, M.D.

  • Interventional Cardiology Physician
  • Slidell, LA
National Provider Identifier
1528178415
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
13606R Issued in LA
Practice address
1051 Gause Blvd.
Suite 230
Slidell, LA 70458
Phone
(985) 641-7577
Fax
(985) 643-0826
NPI assigned
Aug 30, 2006
Last updated
Apr 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 16691 MS
Cardiovascular Disease Physician 207RC0000X MD.13606R LA
Interventional Cardiology Physician 207RI0011X 13606R LA Primary

Addresses

Primary practice location

1051 Gause Blvd.
Suite 230
Slidell, LA 70458

Mailing address

4507 15TH Street
Gulfport, MS 39501
Phone (228) 863-9999

Other practice location 1

1051 Gause Blvd Ste 320
Slidell, LA 70458-2988
Phone (985) 641-7577

Other identifiers 2

IdentifierTypeStateIssuer
00121860MedicaidMS
P00788878OtherMSRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040419000053 MS Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 7214922301 Reassigns benefits to 2 organizations
I20180912001857 LA Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 7214922301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

1391 Broad Ave
Suite a
Gulfport, MS 39501-2419
Phone (228) 863-8868

1397 Broad Ave
Gulfport, MS 39501-2419
Phone (228) 575-1945

147 Reynoir St
Biloxi, MS 39530-4119

1756 Popps Ferry Rd
Biloxi, MS 39532-2118

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

4507 15TH St
Gulfport, MS 39501-2500
Phone (228) 575-1834

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13606RLAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Jun 15, 2020 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Ochsner Mississippi, LLC CurrentSince Aug 31, 2020 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Feb 1, 2025 Accepting new patients
Ochsner Mississippi, LLC CurrentSince Aug 31, 2020 Accepting new patients
Ochsner Clinic LLC Current Accepting new patients
Ochsner Mississippi, LLC Current Accepting new patients
Ochsner Clinic LLC CurrentSince Jun 15, 2020 Accepting new patients

Locations

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

1001 Gause Blvd
Slidell, LA 70458
Phone (985) 280-2200

1051 Gause Blvd
Ste 230
Slidell, LA 70458
Phone (985) 280-9855

1051 Gause Blvd
Ste 320
Slidell, LA 70458
Phone (985) 641-7577

149 Drinkwater Rd
Bay St Louis, MS 39520
Phone (228) 467-8600

4540 Shepherd Sq
#C
Diamondhead, MS 39525
Phone (228) 255-8526

14055 Seaway Rd
Gulfport, MS 39503
Phone (228) 868-5555

14055 Seaway Rd
#8187
Gulfport, MS 39503

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

1839 Cooper Rd
Ste 100
Picayune, MS 39466
Phone (601) 651-3500

Organizations & group practices 11

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.

Hospital & facility affiliations 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1528178415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4507 15TH STREET",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-863-9999",
            "fax_number": "228-863-9955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 GAUSE BLVD.",
            "address_2": "SUITE 230",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "70458",
            "telephone_number": "985-641-7577",
            "fax_number": "985-643-0826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1051 Gause Blvd Ste 320",
            "address_purpose": "LOCATION",
            "city": "Slidell",
            "state": "LA",
            "postal_code": "704582988",
            "country_code": "US",
            "telephone_number": "985-641-7577",
            "fax_number": "985-643-0826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BETHALA",
        "first_name": "CYRIL",
        "middle_name": "VK",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MS",
            "license": "16691",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "MD.13606R",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "LA",
            "license": "13606R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121860",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00788878",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

Verify at the official NPI Registry.