NPIMap

Individual provider Active NPI

Benjamin Z Bennov, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1083603104
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD037759E Issued in PA
Practice address
9630 Bustleton Ave
Suite a
Philadelphia, PA 19115-3102
Phone
(215) 671-1484
Fax
(215) 671-1485
NPI assigned
Oct 20, 2005
Last updated
Jun 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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 MD037759E PA Primary

Addresses

Primary practice location

9630 Bustleton Ave
Suite a
Philadelphia, PA 19115-3102

Mailing address

9630 Bustleton Ave
Suite a
Philadelphia, PA 19115-3102
Phone (215) 671-1484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100924000028 PA Practitioner - Internal Medicine 7810956851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

9630 Bustleton Ave
Suite a
Philadelphia, PA 19115-3102
Phone (215) 671-1484

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD037759EPAMDInternal Medicine Physician

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1083603104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9630 BUSTLETON AVE",
            "address_2": "SUITE A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153102",
            "telephone_number": "215-671-1484",
            "fax_number": "215-671-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9630 BUSTLETON AVE",
            "address_2": "SUITE A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153102",
            "telephone_number": "215-671-1484",
            "fax_number": "215-671-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNOV",
        "first_name": "BENJAMIN",
        "middle_name": "Z",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD037759E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.