BLAKE BETTIS PSYD
NPI 1003650813
Psychologist in Madison, WI

Active since June 25, 2024PECOS EnrolledAccepts Medicare Assignment
1750 FORDEM AVE APT 704, MADISON, WI 53704(470) 331-2534 Get Directions Write a Review

NPPES record last updated: June 25, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Blake Bettis Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE BETTIS PSYD (NPI 1003650813) is an individual psychologist in Madison, Wisconsin, licensed in Wisconsin (5124-57) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1003650813
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameBLAKE BETTISCredential: PSYD
Location Address1750 FORDEM AVE APT 704Madison, WI 53704-7135
Mailing Address1750 Fordem Ave Apt 704Madison, WI 53704-7135 · (470) 331-2534
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJune 25, 2024
NPPES CertifiedJune 24, 2024
✔ NPI 1003650813 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in WI · 5124-57
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
1750 FORDEM AVE APT 704, Madison, WI 53704

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Blake Bettis Psyd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2961909510
PECOS Enrollment IDI20251009000065
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Blake Bettis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Community/Behavioral Health
6548 TOWN CENTER DR STE D
Clarkston, MI 48346
  • Reassigned Medicare billing, Wisconsin enrollment
  • Medicare enrollment name: Richard Kneip Phd PC
  • 44 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Bettis's NPI number?

The NPI number for Blake Bettis is 1003650813. It was assigned to this individual provider in the NPPES registry on June 25, 2024.

Where is Blake Bettis located?

Blake Bettis practices at 1750 Fordem Ave Apt 704, Madison, WI 53704. The listed phone number is (470) 331-2534.

What is Blake Bettis's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Blake Bettis enrolled in Medicare?

Yes. Blake Bettis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Blake Bettis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Blake Bettis reassigns Medicare benefits to Richard Kneip, Ph.D., P.C. (Clarkston, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Blake Bettis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Blake Bettis accept?

Health plans from Anthem Blue Cross and Blue Shield, Dean Health Plan, Medica, Quartz and UnitedHealthcare list Blake Bettis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Blake Bettis was last updated on June 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.