KELLY MARIE BETHUNE DO
NPI 1477940690
Pediatrics in West Islip, NY
About Kelly Marie Bethune Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY MARIE BETHUNE DO (NPI 1477940690) is an individual pediatrics provider in West Islip, New York, licensed in New York (292206) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2015).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Marie Bethune Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Bethune reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
West Islip, NY 11795
- Reassigned Medicare billing, New York enrollment
- 395 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 11795 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
WEST ISLIP, NY 11795
WEST ISLIP, NY 11795
WEST ISLIP, NY 11795
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 Kelly Bethune's NPI number?
The NPI number for Kelly Bethune is 1477940690. It was assigned to this individual provider in the NPPES registry on April 26, 2015.
Where is Kelly Bethune located?
Kelly Bethune practices at 1000 Montauk Hwy, West Islip, NY 11795. The listed phone number is (631) 376-4444.
What is Kelly Bethune's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Kelly Bethune enrolled in Medicare?
Yes. Kelly Bethune is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Bethune's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Bethune reassigns Medicare benefits to Good Samaritan Hospital Medical Center (West Islip, NY). 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 Kelly Bethune's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Bethune was last updated on August 13, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Kelly Marie Bethune, DO · NPI 1477940690
Pediatrics physician in West Islip, New York. Individual provider, active in the CMS NPPES registry since April 26, 2015.
## Identity
- **NPI:** 1477940690 (Entity type: Individual)
- **Enumerated:** April 26, 2015
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 292206 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 1000 MONTAUK HWY, West Islip, NY 11795-4927
- **Phone:** (631) 376-4444
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Good Samaritan Hospital Medical Center (NPI 1518901180, West Islip, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2015
## Record status
- **NPPES last updated:** August 13, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1477940690) · Data from the CMS NPPES public registry.