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AMY BETH DETTORI M.D.
NPI 1174751325
Pediatrics - Pediatric Pulmonology in Oak Harbor, WA

Active since June 26, 2009PECOS Enrolled
3475 N SARATOGA ST, BLDG 993, OAK HARBOR, WA 98278(360) 257-9406 Get Directions Write a Review

NPPES record last updated: June 10, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Amy Beth Dettori M.d. NPPES

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

AMY BETH DETTORI M.D. (NPI 1174751325) is an individual pediatric pulmonology provider in Oak Harbor, Washington, licensed in Washington (MD61153930) and active in the NPI registry since June 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174751325
Entity TypeIndividualFemale
Primary Taxonomy2080P0214X
Provider Legal NameAMY BETH DETTORICredential: M.D.
Location Address3475 N SARATOGA ST, BLDG 993Oak Harbor, WA 98278-8800
Mailing Address6034 40th Ave NeSeattle, WA 98115-7502 · (206) 765-6766
Phone(360) 257-9406
Sole ProprietorNo
Enumeration DateJune 26, 2009
Last NPPES UpdateJune 10, 2021
NPPES CertifiedJune 10, 2021
✔ NPI 1174751325 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatrics · Pediatric PulmonologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0214X
License✔ Licensed in WA · MD61153930
Definition
A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques.
Also ListedPreventive Medicine · Aerospace MedicineTaxonomy 2083A0100X · License 01068606A (IN)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
3475 N SARATOGA ST, Oak Harbor, WA 98278
Open in Google Maps ↗

Other Names 1

Former Name (1)Amy Beth Clark M.d.

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amy Beth Dettori M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Amy Dettori reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Association Of Chmc And University Physicians
50 mi
Trauma Surgery
4800 SAND POINT WAY NE
Seattle, WA 98105
  • Reassigned Medicare billing, Washington enrollment
  • Medicare enrollment name: The Association Of Chrmc And University Physicians
  • 1,443 clinicians in this Medicare group
NPI 1649497827 (206) 987-2000

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

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REINA LORENE LOPEZ DO
General Practice
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9918
DR. CHRISTIAN MASCARO DO
General Practice
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9500
FRANK WILLIAM HOLIBER DO
General Practice
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9500
EMILY LYNETTE POE
General Practice
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (367) 257-9651
DR. VERNON DALE MORGAN M.D.
Family Medicine
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9918
DR. KATHLEEN SLOCUM MD
Radiology (Diagnostic Radiology)
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9640
KELLI RANDELL M.D.
Internal Medicine
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9561
MRS. LISA SUZANNE CZUBERNAT NURSE
Registered Nurse (Case Management)
3475 N SARATOGA ST
OAK HARBOR, WA 98278
Island County (360) 257-9833

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 Amy Dettori's NPI number?

The NPI number for Amy Dettori is 1174751325. It was assigned to this individual provider in the NPPES registry on June 26, 2009. The provider is also known as Amy Beth Clark M.D..

Where is Amy Dettori located?

Amy Dettori practices at 3475 N Saratoga St Bldg 993, Oak Harbor, WA 98278. The listed phone number is (360) 257-9406.

What is Amy Dettori's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Pulmonology, with taxonomy code 2080P0214X.

Is Amy Dettori enrolled in Medicare?

Yes. Amy Dettori is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Amy Dettori's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Amy Dettori reassigns Medicare benefits to Association Of Chmc And University Physicians (Seattle, WA). 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 Amy Dettori's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Amy Dettori accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Amy Dettori 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 Amy Dettori was last updated on June 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.