Individual provider Active NPI

Bettina Watkins, MD

  • Family Medicine Physician
  • Shaw AFB, SC
National Provider Identifier
1700042306
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
27143 Issued in OK
Practice address
420 Polifka Dr BLDG 1042
Shaw AFB, SC 29152-5100
Phone
(803) 895-6654
NPI assigned
Aug 3, 2008
Last updated
Jan 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 27143 OK Primary
General Practice Physician 208D00000X 27143 OK

Addresses

Primary practice location

420 Polifka Dr BLDG 1042
Shaw AFB, SC 29152-5100

Mailing address

420 Polifka Dr
Shaw AFB, SC 29152-5100
Phone (803) 895-6356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151030001251 NE Order and Referring Only - Family PracticePractitioner - Family Practice 8224348479

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27143OKMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1217721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1700042306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "803-895-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR BLDG 1042",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "803-895-6654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "BETTINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-03",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "27143",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OK",
            "license": "27143",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shaw AFB, SC

Sources for this page

Verify at the official NPI Registry.