Mary Taylor Benson
Individual provider Active NPI Nurse Practitioner · Lakeport, CA
NPI 1043602147 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1043602147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN.CNP.0041364 (OH)
- Practice address
- 987 Parallel Dr Ste C
Lakeport, CA 95453-5708 - Phone
- (707) 262-5088
- NPI assigned
- Feb 26, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 24
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sutter Lakeside Home Medical Services
Sutter Bay Hospitals
Practice addresses (Care Compare)
5176 Hill Rd E
Lakeport, CA 95453-6300
987 Parallel Dr
Suite C
Lakeport, CA 95453-5708
Phone (707) 262-5088
Hospital & facility affiliations
- Sutter Care at Home
- Sutter Lakeside Hospital
- Adventist Health Clearlake
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241126004033 | CA | Practitioner - Nurse Practitioner | 8022345065 | Reassigns benefits to 1 organization |
| I20260428000838 | OH | Practitioner - Nurse Practitioner | 8022345065 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95010828 | CA | MD | Family Nurse Practitioner |
| R863948 | MS | MD | Family Health Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutter Bay Hospitals | Current |
Accepting new patients | |
| Sutter Bay Hospitals | Current |
Accepting new patients | |
| Sutter Bay Hospitals | Current | Accepting new patients |
Locations
5176 Hill Rd E
Lakeport, CA 95453
Phone (707) 262-5000
5196 Hill Rd E
Ste 300
Lakeport, CA 95453
Phone (707) 263-6885
987 Parallel Dr
Ste C
Lakeport, CA 95453
Phone (707) 262-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Health Clinical Nurse Specialist | 364SF0001X | R863948 | MS | |
| Nurse Practitioner | 363L00000X | APRN.CNP.0041364 | OH | Yes |
| Family Nurse Practitioner | 363LF0000X | NP95010828 | CA | |
| Family Nurse Practitioner | 363LF0000X | AP60909312 | WA | |
| Family Nurse Practitioner | 363LF0000X | 8067 | CT |
Addresses
Primary practice location
987 Parallel Dr Ste C
Lakeport, CA 95453-5708
Mailing address
1010 Mint Springs Rd
Terry, MS 39170-8778
Other practice location 1
300 Nissan Dr
Canton, MS 39046-8562
Phone (601) 855-8426
Other practice location 2
85 Lafayette St
New Britain, CT 06051-1803
Phone (860) 347-6971
Other practice location 3
8740 Orion Pl Ste 100
Columbus, OH 43240-4063
Phone (614) 300-5913
Other practice location 4
5196 Hill Rd E Ste 300
Lakeport, CA 95453-6374
Phone (916) 263-6885
Other practice location 5
1251 Lewis River Rd Ste D
Woodland, WA 98674-9203
Phone (360) 225-4310
Other names
- Mary Taylor
Other providers in Lakeport, CA
- Kristina Ballard
- Jillian R Barna
- Cynthia Barnes
- Charissa M Barsos
- Harneet Singh Bath
- Shawna Berglund
- Lisa M Bermudez
- David Betat
- Evan John Bettey
- Kimberly Bigelman
All providers in Lakeport, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.