NPIMap

Individual provider Active NPI

Jonathan James Bennett, MD

  • Family Medicine Physician
  • Watertown, MN
National Provider Identifier
1003479171
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
71173 Issued in MN
Practice address
313 Territorial St E
Watertown, MN 55388-9284
Phone
(952) 955-1921
NPI assigned
Apr 15, 2019
Last updated
Dec 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 71173 MN Primary

Addresses

Primary practice location

313 Territorial St E
Watertown, MN 55388-9284

Mailing address

424 MN-5
Waconia, MN 55387
Phone (952) 442-4461

Other names 1

  • Dr. JJ Bennett Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220726002672 MN Practitioner - Family Practice 3678807658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tulane University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeview Clinic, LTD.Group PAC ID 6002801453, 52 clinicians

Practice addresses (Care Compare)

313 Territorial St E
Watertown, MN 55388-9284
Phone (952) 442-4461

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71173MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Clinic, LTD. CurrentSince Aug 31, 2022 Accepting new patients

Locations

110105 Pioneer Trl W
Chaska, MN 55318
Phone (952) 361-5800

110105 Pioneer Trl W
#100
Chaska, MN 55318
Phone (952) 556-0120

406 Faxon Rd N
Nya, MN 55368
Phone (952) 467-1915

424 W State Highway 5
Waconia, MN 55387
Phone (952) 442-4461

313 Territorial St E
Watertown, MN 55388
Phone (952) 442-4461

Interoperability endpoints

  • Direct secure messaging: jonathanbennett@tv.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1003479171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 MN-5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "55387",
            "telephone_number": "952-442-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 TERRITORIAL ST E",
            "city": "WATERTOWN",
            "state": "MN",
            "postal_code": "553889284",
            "telephone_number": "952-955-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JONATHAN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-15",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "71173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JJ",
            "last_name": "BENNETT",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watertown, MN

Sources for this page

Verify at the official NPI Registry.