Susan Beyer Bertelsen, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11214 Issued in CA

Practice address

2100 Powell St Ste 900
Cep - Medamerica Provider Enrollment
Emeryville, CA 94608-1844

Phone

(510) 350-2676

Fax

(510) 879-9100

NPI assigned

Mar 16, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790809739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 DUNCAN PL",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943064551",
            "telephone_number": "650-493-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST STE 900",
            "address_2": "CEP - MEDAMERICA PROVIDER ENROLLMENT",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081844",
            "telephone_number": "510-350-2676",
            "fax_number": "510-879-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTELSEN",
        "first_name": "SUSAN",
        "middle_name": "BEYER",
        "credential": "P.A.-C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN'S ASSISTANT",
            "identifier": "PA11214",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isheh Beck
• Leanne Therese Beckstrom, PA-C
• Ja Mes Tecora Rose Belcher, BT
• Troy Benfield, D.C.
• Turshika Bennett
• Brianna Bilotta
• Avrille Birnbaum, PSY.D.
• Emily Hunter Birnbaum, FNP
• Michelle Black
• Will Richard Blackmon III, PA-C

• Physician Assistant in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.