Individual provider Active NPI

Benedicta G Enrile, MD

  • Pediatric Neurodevelopmental Disabilities Physician
  • Columbus, OH
National Provider Identifier
1023010907
Registry record updated Sep 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X
License
35034843 Issued in OH
Practice address
555 S 18TH St
Columbus, OH 43205-2654
Phone
(614) 722-2438
Fax
(614) 722-4966
NPI assigned
Aug 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X 35034843 OH Primary

Addresses

Primary practice location

555 S 18TH St
Columbus, OH 43205-2654

Mailing address

555 S 18TH St
Columbus, OH 43205-2654
Phone (614) 722-2438

Other identifiers 3

IdentifierTypeStateIssuer
0105149000MedicaidWV
64789043MedicaidKY
0252524MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35034843OHMDPediatric Neurodevelopmental Disabilities Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222214400000",
    "number": "1023010907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S 18TH ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052654",
            "telephone_number": "614-722-2438",
            "fax_number": "614-722-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S 18TH ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052654",
            "telephone_number": "614-722-2438",
            "fax_number": "614-722-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENRILE",
        "first_name": "BENEDICTA",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2008-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "OH",
            "license": "35034843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105149000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64789043",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0252524",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.