Cami Ann Bertus, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.772 Issued in AL

Practice address

380 Woods Cove Rd
Scottsboro, AL 35768-2428

Phone

(256) 259-4444

NPI assigned

Aug 30, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Other names 1

• Cami Ann Neal Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1609060862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 WOODS COVE RD",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682428",
            "telephone_number": "256-259-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 WOODS COVE RD",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682428",
            "telephone_number": "256-259-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Micah Way Ste 1107",
            "address_purpose": "LOCATION",
            "city": "Scottsboro",
            "state": "AL",
            "postal_code": "357694161",
            "country_code": "US",
            "telephone_number": "256-259-4408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTUS",
        "first_name": "CAMI",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA1375",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158202",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPSP",
            "identifier": "772-4235",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QACSC",
            "identifier": "772-4235",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA1375",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOT NATIONAL REGISTRY",
            "identifier": "7203722930",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA.772",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF ALABAMA",
            "identifier": "511-46004",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAMI",
            "last_name": "NEAL",
            "middle_name": "ANN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dennis John Basila, M.D.
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• Kaitlyn A Bennett, NP
• Patrick Scott Berry, M.D.
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• Tiffany A Bierman, RD, LDN
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• Physician Assistant in Scottsboro, AL
• Providers in Scottsboro, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.