Active NPI
Bethany Marie Deboer, DO
- Family Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1710143490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 6327
- Practice address
- 4021 S Walker Ave Ste 201
Oklahoma City, OK 73109 - Phone
- (405) 632-6688
- Fax
- (405) 595-3247
- NPI assigned
- Aug 1, 2008
- Last updated
- Nov 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 009821 | AZ | |
| Family Medicine Physician | 207Q00000X | Q4083 | TX | |
| Family Medicine Physician | 207Q00000X | 6327 | OK | Primary |
Addresses
Primary practice location
4021 S Walker Ave Ste 201
Oklahoma City, OK 73109
Mailing address
3000 N Grand Blvd
Oklahoma City, OK 73107-1818
Phone (405) 632-6688
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190211003105 | OK | Practitioner - Family Practice | 8325211022 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Touro Un Col of Osteopathic Medicine, Henderson, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
101 Mission St
Suite 800
San Francisco, CA 94105-1705
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6327 | OK | MD | Mental Health Counselor |
| 009821 | AZ | MD | Family Medicine Physician |
| Q4083 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- bdeboer46832@direct.phhs.org
Organizations & group practices 2
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.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
-
dba Ozarks Healthcare
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701129600000",
"number": "1710143490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 N GRAND BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731071818",
"telephone_number": "405-632-6688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4021 S WALKER AVE STE 201",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "73109",
"telephone_number": "405-632-6688",
"fax_number": "405-595-3247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBOER",
"first_name": "BETHANY",
"middle_name": "MARIE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-01",
"last_updated": "2023-11-28",
"certification_date": "2023-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "009821",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "Q4083",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "6327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.