Individual provider Active NPI

S Charles Bennett IV, AA

  • Anesthesiologist Assistant
  • Dallas, TX
National Provider Identifier
1023435500
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
9529 Issued in GA
Practice address
12222 Merit Dr Ste 600
Dallas, TX 75251-3294
Phone
(972) 715-5000
Fax
(972) 715-9976
NPI assigned
Mar 24, 2014
Last updated
Oct 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X AA000040 DC
Anesthesiologist Assistant 367H00000X 1543 TX
Anesthesiologist Assistant 367H00000X 9529 GA Primary

Addresses

Primary practice location

12222 Merit Dr Ste 600
Dallas, TX 75251-3294

Mailing address

PO Box 840853
Dallas, TX 75284-0853
Phone (972) 233-1999

Other practice location 1

110 Irving St NW
Washington, DC 20010-3017
Phone (202) 877-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, GA, TX3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140717001044 DC Practitioner - Anesthesiology Assistant 4082830633 Reassigns benefits to 1 organization
I20200410002260 GA Practitioner - Anesthesiology Assistant 4082830633 Reassigns benefits to 2 organizations
I20220805001220 TX Practitioner - Anesthesiology Assistant 4082830633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology Associates of Georgia LLCGroup PAC ID 7618934779, 230 clinicians

Practice addresses (Care Compare)

5353 Reynolds St
Savannah, GA 31405-6015
Phone (912) 819-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.94 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
AA000040DCMDAnesthesiologist Assistant
1543TXMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
U S Anesthesia Partners of Texas, PA CurrentSince Jul 22, 2022 Accepting new patients
Washington Hospital Center Corp CurrentSince Apr 21, 2014 Accepting new patients
American Anesthesiology Associates of Georgia, LLC CurrentSince Sep 15, 2024 Accepting new patients
U. S. Anesthesia Partners of Texas, P.a., Anesthesiologist Assistant CurrentSince Jul 22, 2022 Accepting new patients
Washington Hospital Center Corp CurrentSince Apr 21, 2014 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Feb 15, 2020 Accepting new patients

Locations

110 Irving St NW
Washington, DC 20010
Phone (202) 877-2000

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

247 S Main St
Reidsville, GA 30453
Phone (478) 787-6255

11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

5353 Reynolds St
Savannah, GA 31405
Phone (912) 692-6172

215 Mims Rd
Sylvania, GA 30467
Phone (912) 557-1207

7503 Surratts Rd
Clinton, MD 20735
Phone (301) 868-8000

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

12222 Merit Dr
Ste 600
Dallas, TX 75251
Phone (855) 464-8727

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

7930 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 297-5000

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

Organizations & group practices 6

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 2

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": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1023435500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840853",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840853",
            "telephone_number": "972-233-1999",
            "fax_number": "972-233-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12222 MERIT DR STE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752513294",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Irving St NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200103017",
            "country_code": "US",
            "telephone_number": "202-877-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "S CHARLES",
        "name_suffix": "IV",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-24",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "DC",
            "license": "AA000040",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "TX",
            "license": "1543",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "9529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.