NPIMap

Individual provider Active NPI

Yashashree L Bethala, MD

  • Internal Medicine Physician
  • Biloxi, MS
National Provider Identifier
1659333052
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16718 Issued in MS
Practice address
147 Reynoir Street
Suite 101
Biloxi, MS 39530
Phone
(228) 374-2051
Fax
(228) 374-5741
NPI assigned
Apr 3, 2006
Last updated
Dec 16, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16718 MS Primary

Addresses

Primary practice location

147 Reynoir Street
Suite 101
Biloxi, MS 39530

Mailing address

147 Reynoir Street
Suite 101
Biloxi, MS 39530
Phone (228) 374-2051

Other identifiers 1

IdentifierTypeStateIssuer
0122367MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20080606000704 MS Practitioner - Internal Medicine 1254401946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Biloxi Internal Medicine Clinic PAGroup PAC ID 9638249352, 4 clinicians

Practice addresses (Care Compare)

147 Reynoir St
Suite 101
Biloxi, MS 39530-4119
Phone (228) 374-2051

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16718MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Biloxi Internal Medicine Clinic PA Internal Medicine CurrentSince Apr 3, 2000 Accepting new patients
Vivian K. Bethala, MD PA Past Accepting new patients
Biloxi Hma LLC Internal Medicine Past Accepting new patients

Locations

147 Reynoir St
Ste 101
Biloxi, MS 39530
Phone (228) 374-2051

147 Reynoir St
Ste 204
Biloxi, MS 39530
Phone (228) 374-6296

Organizations & group practices 3

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 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1659333052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 REYNOIR STREET",
            "address_2": "SUITE 101",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39530",
            "telephone_number": "228-374-2051",
            "fax_number": "228-374-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 REYNOIR STREET",
            "address_2": "SUITE 101",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39530",
            "telephone_number": "228-374-2051",
            "fax_number": "228-374-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHALA",
        "first_name": "YASHASHREE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-03",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "16718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0122367",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.