Active NPI
Mark Arden Benedict, ATC, LAT
- Athletic Trainer
- Lake Mary, FL
National Provider Identifier
1083993489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL 1110
- Practice address
- 1341 Arbor Vista Loop
# 225
Lake Mary, FL 32746-1683 - Phone
- (386) 747-0790
- NPI assigned
- Aug 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL 1110 | FL | Primary |
Addresses
Primary practice location
1341 Arbor Vista Loop
# 225
Lake Mary, FL 32746-1683
Mailing address
1341 Arbor Vista Loop
# 225
Lake Mary, FL 32746-1683
Phone (386) 747-0790
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL 1110 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313452800000",
"number": "1083993489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 ARBOR VISTA LOOP",
"address_2": "# 225",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327461683",
"telephone_number": "386-747-0790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 ARBOR VISTA LOOP",
"address_2": "# 225",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327461683",
"telephone_number": "386-747-0790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENEDICT",
"first_name": "MARK",
"middle_name": "ARDEN",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-16",
"last_updated": "2011-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL 1110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.