Individual provider Active NPI

John Riley Benock, DPT

  • Physical Therapist
  • Elizabethtown, KY
National Provider Identifier
1104240100
Registry record updated Apr 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
006364 Issued in KY
Practice address
4031 N Dixie Hwy Ste 104
Elizabethtown, KY 42701-7874
Phone
(270) 982-4776
NPI assigned
Feb 11, 2014
Last updated
Apr 24, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 006364 KY Primary

Addresses

Primary practice location

4031 N Dixie Hwy Ste 104
Elizabethtown, KY 42701-7874

Mailing address

4031 N Dixie Hwy Ste 104
Elizabethtown, KY 42701-7874
Phone (270) 982-4776

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190508003251 KY Practitioner - Physical Therapist in Private Practice 0244572402 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
006364KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
PT Pros, Inc. Physical Therapist CurrentSince Aug 2, 2021 Accepting new patients
PT Pros, Inc. Physical Therapist CurrentSince Aug 2, 2021 Accepting new patients
PT Pros, Inc. Physical Therapist Current Accepting new patients
PT Pros, Inc. Physical Therapist Past Accepting new patients
PT Pros, Inc. Physical Therapist Past Accepting new patients
PT Pros Inc Physical Therapist Past Accepting new patients
PT Pros, Inc. Physical Therapist Past Accepting new patients
PT Pros, Inc. Physical Therapist Past Accepting new patients

Locations

383 Corbin Center Dr
Corbin, KY 40701
Phone (606) 526-2909

4031 N Dixie Hwy
Ste 104
Elizabethtown, KY 42701
Phone (270) 982-4776

4201 Springhurst Blvd
Ste 101
Louisville, KY 40241
Phone (502) 805-7092

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1104240100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4031 N DIXIE HWY STE 104",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017874",
            "telephone_number": "270-982-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4031 N DIXIE HWY STE 104",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017874",
            "telephone_number": "270-982-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENOCK",
        "first_name": "JOHN",
        "middle_name": "RILEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-11",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; 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.