Bethany Jo Mathis

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

411A Red Bud LN
Troy, IL 62294-1061

Phone

(618) 841-6021

NPI assigned

Nov 14, 2019

Last updated

Nov 14, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Delta Gamma Center for Children With Visual Impairments

  • Customized Equipment (DME)
  • Richmond Heights, MO
  • NPI 1780711192
  NPD (past)

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1528603404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411A RED BUD LN",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941061",
            "telephone_number": "618-841-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411A RED BUD LN",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941061",
            "telephone_number": "618-841-6021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1750 S Big Bend Blvd",
            "address_purpose": "LOCATION",
            "city": "Richmond Heights",
            "state": "MO",
            "postal_code": "631172402",
            "country_code": "US",
            "telephone_number": "314-776-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "BETHANY",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Leanne M McDonald
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• Kellie Meyer, MA CCC-SLP
• Isabella Miller

• Developmental Therapist in Troy, IL
• Providers in Troy, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.