NPIMap

Individual provider Active NPI

Benjamin J Bronicel, MD

  • Emergency Medicine Physician
  • Springfield, OR
National Provider Identifier
1093769929
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD23040 Issued in OR
Practice address
1460 G St
Springfield, OR 97477-4112
Phone
(541) 726-4400
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD23040 OR Primary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X MD23040 OR

Addresses

Primary practice location

1460 G St
Springfield, OR 97477-4112

Mailing address

PO Box 11840
Westminster, CA 92685-1840
Phone (800) 511-4875

Other identifiers 1

IdentifierTypeStateIssuer
287655MedicaidOR

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23040ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Emergency Room Physicians, Inc P.S. Emergency Medicine PastSince Jan 10, 2021 Accepting new patients
Doctors Emergency Room Corp PC Emergency Medicine PastSince Jul 1, 2013 Accepting new patients
Benjamin J. Bronicel, MD P.C. Emergency Medicine PastSince Jan 1, 2003 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1804/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1093769929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11840",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926851840",
            "telephone_number": "800-511-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 G ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774112",
            "telephone_number": "541-726-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONICEL",
        "first_name": "BENJAMIN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD23040",
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "OR",
            "license": "MD23040",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287655",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; 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.