Individual provider Active NPI

Benjamin L Kohnen, MD

  • Family Medicine Physician
  • Saline, MI
National Provider Identifier
1063675635
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301110377 Issued in MI
Practice address
208 W Bennett St
Saline, MI 48176-1105
Phone
(734) 429-9377
Fax
(734) 429-8277
NPI assigned
Jul 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301110377 MI Primary

Addresses

Primary practice location

208 W Bennett St
Saline, MI 48176-1105

Mailing address

208 W Bennett St
Saline, MI 48176-1105
Phone (734) 429-9377

Other practice location 1

3145 W Clark Rd
Suite 401
Ypsilanti, MI 48197-1120
Phone (734) 528-5700

Other practice location 2

3145 W Clark Rd
Suite 401
Ypsilanti, MI 48197-1120
Phone (734) 528-5700

Other identifiers 1

IdentifierTypeStateIssuer
1063675635MedicaidMI

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301110377MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Floyd County Memorial Hospital Commission Family Medicine Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1063675635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W BENNETT ST",
            "city": "SALINE",
            "state": "MI",
            "postal_code": "481761105",
            "telephone_number": "734-429-9377",
            "fax_number": "734-429-8277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W BENNETT ST",
            "city": "SALINE",
            "state": "MI",
            "postal_code": "481761105",
            "telephone_number": "734-429-9377",
            "fax_number": "734-429-8277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3145 W Clark Rd",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481971120",
            "country_code": "US",
            "telephone_number": "734-528-5700",
            "fax_number": "734-528-5701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3145 W Clark Rd",
            "address_2": "Suite 401",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481971120",
            "country_code": "US",
            "telephone_number": "734-528-5700",
            "fax_number": "734-528-5701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOHNEN",
        "first_name": "BENJAMIN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301110377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063675635",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saline, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.