Individual provider Active NPI

Kristina Jo Bethel, D.O.

  • Emergency Medicine Physician
  • Jackson, MS
National Provider Identifier
1962790709
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T-2507 Issued in MS
Practice address
2500 N State St
University of Mississippi Medical Center
Jackson, MS 39216-4505
Phone
(601) 984-5582
NPI assigned
Jul 14, 2011
Last updated
Jun 29, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X T-2507 MS Primary

Addresses

Primary practice location

2500 N State St
University of Mississippi Medical Center
Jackson, MS 39216-4505

Mailing address

105 Concord PL
Madison, MS 39110-7541
Phone (305) 978-9769

Other names 1

  • Kristina Jo Sikes Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20160726002539 TN Practitioner - Emergency Medicine 8123241650 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergi-TrustGroup PAC ID 3375448699, 17 clinicians

Practice addresses (Care Compare)

4321 Carothers Pkwy
Franklin, TN 37067-5909
Phone (781) 280-1640

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.65 of 100Reported as group
Quality
78.55
Improvement activities
40
Cost
74.82

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T-2507MSMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergi-Trust Emergency Medicine CurrentSince Jul 1, 2018 Accepting new patients
Emergency Medicine Services of TN, PC Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients

Locations

111 Highway 70 E
Dickson, TN 37055
Phone (615) 441-2357

4321 Carothers Pkwy
Franklin, TN 37067
Phone (615) 435-5000

2300 Patterson St
Nashville, TN 37203
Phone (615) 342-1500

391 Wallace Rd
Nashville, TN 37211
Phone (615) 332-6253

200 Stonecrest Blvd
Smyrna, TN 37167
Phone (615) 768-2000

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.

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": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1962790709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 CONCORD PL",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107541",
            "telephone_number": "305-978-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164505",
            "telephone_number": "601-984-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETHEL",
        "first_name": "KRISTINA",
        "middle_name": "JO",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "T-2507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "SIKES",
            "middle_name": "JO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.