NPIMap

Individual provider Active NPI

Eric Olson Benner, M.D.

  • Internal Medicine Physician
  • Mission Viejo, CA
National Provider Identifier
1063648343
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A107675 Issued in CA
Practice address
26800 Crown Valley Pkwy Ste 315
Mission Viejo, CA 92691-8039
Phone
(949) 364-6000
Fax
(949) 364-1204
NPI assigned
Jun 1, 2009
Last updated
Oct 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A107675 CA Primary

Addresses

Primary practice location

26800 Crown Valley Pkwy Ste 315
Mission Viejo, CA 92691-8039

Mailing address

26800 Crown Valley Pkwy Ste 315
Mission Viejo, CA 92691-8039
Phone (949) 364-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ebenner1373971@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100922000534 CA Practitioner - Internal Medicine 5991821456 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Ohio, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cognacare Neurologic IncGroup PAC ID 4981125531, 17 clinicians
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1451 E Chevy Chase Dr
Suite 201
Glendale, CA 91206-4056
Phone (818) 265-2245

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

24321 Avenida de la Carlota
Laguna Hills, CA 92653-3681
Phone (949) 204-3006

26800 Crown Valley Pkwy
Mission Viejo, CA 92691-6384

27799 Medical Ctr Rd
Mission Viejo, CA 92691-6400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jan 1, 2013 Accepting new patients
Providence Medical Foundation CurrentSince Jan 1, 2013 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

26800 Crown Valley Pkwy
Ste 300
Mission Viejo, CA 92691

26800 Crown Valley Pkwy
Ste 315
Mission Viejo, CA 92691
Phone (949) 364-6001

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 8

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": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634256000000",
    "number": "1063648343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 315",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918039",
            "telephone_number": "949-364-6000",
            "fax_number": "949-364-1204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 315",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918039",
            "telephone_number": "949-364-6000",
            "fax_number": "949-364-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNER",
        "first_name": "ERIC",
        "middle_name": "OLSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-01",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A107675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebenner1373971@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "26800 Crown Valley Pkwy Ste 315",
            "city": "Mission Viejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926918039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.