Individual provider Active NPI

Bethany McMullen, DC

  • Chiropractor
  • Watertown, SD
National Provider Identifier
1821688219
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1388 Issued in SD
Practice address
600 5TH St SE Ste 2
Watertown, SD 57201-4915
Phone
(605) 878-0167
NPI assigned
Jan 20, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1388 SD Primary

Addresses

Primary practice location

600 5TH St SE Ste 2
Watertown, SD 57201-4915

Mailing address

600 5TH St SE Ste 2
Watertown, SD 57201-4915
Phone (605) 878-0167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210303000674 SD Practitioner - Chiropractic 4183038151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Peak Chiropractic LLCGroup PAC ID 2365856333, 2 clinicians

Practice addresses (Care Compare)

600 5TH St SE
Suite 2
Watertown, SD 57201-4915
Phone (605) 878-0167

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1388SDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Peak Chiropractic LLC Chiropractor CurrentSince Feb 10, 2021 Accepting new patients

Locations

600 5th St SE
Ste 2
Watertown, SD 57201
Phone (605) 878-0167

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1821688219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 5TH ST SE STE 2",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572014915",
            "telephone_number": "605-878-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 5TH ST SE STE 2",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572014915",
            "telephone_number": "605-878-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMULLEN",
        "first_name": "BETHANY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SD",
            "license": "1388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.