NPIMap

Individual provider Active NPI

Lori Marie Bethke, MD

  • Family Medicine Physician
  • Vadnais Heights, MN
National Provider Identifier
1639193261
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43604 Issued in MN
Practice address
3550 Labore Rd Ste 7
Vadnais Heights, MN 55110-5113
Phone
(651) 766-0520
Fax
(651) 766-9451
NPI assigned
Jul 27, 2006
Last updated
Apr 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 43604 MN Primary

Addresses

Primary practice location

3550 Labore Rd Ste 7
Vadnais Heights, MN 55110-5113

Mailing address

2025 Sloan PL Ste 35
Saint Paul, MN 55117-2092
Phone (651) 772-1572

Other identifiers 1

IdentifierTypeStateIssuer
754463400MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040323001398 MN Practitioner - Family Practice 6103717665 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3550 Labore Rd
Suite 7
Vadnais Heights, MN 55110-5113
Phone (651) 788-4444

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43604MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Nov 25, 2020 Accepting new patients
Family Healthservices Minnesota, P.a. Family Medicine CurrentSince Jan 1, 2008 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Family Healthservices Minnesota, P.a. Family Medicine Past Accepting new patients
East Metro Family Practice, P.a. Family Medicine Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

2025 Sloan Pl
Ste 35
Saint Paul, MN 55117
Phone (651) 772-1572

2601 Centennial Dr
Ste 100
Saint Paul, MN 55109
Phone (651) 777-7414

2716 Upper Afton Rd E
Saint Paul, MN 55119
Phone (651) 739-5050

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

580 Rice St
Saint Paul, MN 55103
Phone (651) 227-6551

404 Highway 96 W
Shoreview, MN 55126
Phone (651) 482-8080

3550 Labore Rd
Ste 7
Vadnais Heights, MN 55110
Phone (651) 766-0520

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: lori.bethke@entira.eclinicaldirectplus.com

Organizations & group practices 8

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1639193261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 SLOAN PL STE 35",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551172092",
            "telephone_number": "651-772-1572",
            "fax_number": "651-772-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 LABORE RD STE 7",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105113",
            "telephone_number": "651-766-0520",
            "fax_number": "651-766-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHKE",
        "first_name": "LORI",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "43604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "754463400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vadnais Heights, MN

Sources for this page

Verify at the official NPI Registry.