NPIMap

Organization Active NPI

Bennett Clinic LLC

  • Physical Therapy Clinic/Center
  • Prescott, AZ
National Provider Identifier
1083946586
Registry record updated Mar 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT 6078 Issued in AZ
Legal business name
BENNETT CLINIC LLC
Practice address
1202 Willow Creek Rd
Prescott, AZ 86301-1428
Phone
(928) 771-9400
Fax
(928) 771-9464
NPI assigned
Feb 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2013

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

Authorized official

Name
Dr. Wayne Anthony Bennett, D.C.NPI 1952386542
Title
Director
Phone
(928) 771-9400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X 5009 AZ
Physical Therapy Clinic/Center 261QP2000X PT 6078 AZ Primary

Addresses

Primary practice location

1202 Willow Creek Rd
Prescott, AZ 86301-1428

Mailing address

1202 Willow Creek Rd
Prescott, AZ 86301-1428
Phone (928) 771-9400

Other names 1

  • Bennett Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100907000243 AZ Part B Supplier - Clinic/Group Practice 4587788062 Receives reassigned benefits from 5 practitioners
Practice locations: Prescott, AZ

National Provider Directory

National Provider Directory
Tax ID family
Bennett Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362528000000",
    "number": "1083946586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011428",
            "telephone_number": "928-771-9400",
            "fax_number": "928-771-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011428",
            "telephone_number": "928-771-9400",
            "fax_number": "928-771-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2013-03-06",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "928-771-9400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "AZ",
            "license": "5009",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "PT 6078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bennett Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.