Individual provider Active NPI

Caleb Bettenhausen

  • Physician Assistant
  • Yakima, WA
National Provider Identifier
1790208973
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2501 Business LN
Yakima, WA 98901-1167
Phone
(509) 575-4800
NPI assigned
Jul 19, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2501 Business LN
Yakima, WA 98901-1167

Mailing address

2019 58TH Ave
Yakima, WA 98903-1194
Phone (406) 218-1105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220523001123 MT Practitioner - Physician Assistant 3678848066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holy Rosary HealthcareGroup PAC ID 8921045667, 49 clinicians

Practice addresses (Care Compare)

2600 Wilson St
Miles City, MT 59301-5094
Phone (406) 233-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Holy Rosary Healthcare CurrentSince Dec 1, 2022 Accepting new patients
Holy Rosary Healthcare CurrentSince Dec 1, 2022 Accepting new patients
Holy Rosary Healthcare Past Accepting new patients

Locations

2600 Wilson St
Miles City, MT 59301
Phone (406) 233-2500

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790208973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 58TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989031194",
            "telephone_number": "406-218-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 BUSINESS LN",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989011167",
            "telephone_number": "509-575-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTENHAUSEN",
        "first_name": "CALEB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.