Individual provider Active NPI

Jeremy A. Benedetti, M.D.

  • Plastic Surgery Physician
  • Seattle, WA
National Provider Identifier
1104938893
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
MD60986017 Issued in WA
Practice address
201 16TH Ave E
Seattle, WA 98112-5226
Phone
(206) 326-3000
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Registered Nurse 163WS0121X 0101263196 VA
Plastic Surgery Physician 208200000X MD24934 OR
Plastic Surgery Physician 208200000X ME99859 FL
Plastic Surgery Physician 208200000X MD60986017 WA Primary

Addresses

Primary practice location

201 16TH Ave E
Seattle, WA 98112-5226

Mailing address

201 16TH Ave E
Seattle, WA 98112-5226
Phone (206) 326-3000

Other practice location 1

70 Medical Center Cir Ste 203
Fishersville, VA 22939-2273
Phone (540) 932-5571

Other practice location 2

1204 W Main St
Charlottesville, VA 22903-2824
Phone (434) 982-6100

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171122000712 VA Practitioner - Plastic and Reconstructive Surgery 2668424391 Reassigns benefits to 1 organization
I20200219002560 WA Practitioner - Plastic and Reconstructive Surgery 2668424391 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD24934ORMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 29, 2019 Accepting new patients
University of Virginia Physicians Group CurrentSince Oct 2, 2017 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Dec 29, 2019 Accepting new patients
Narasimhan Plastic Surgery Plastic Surgery PastSince Dec 16, 2020 Accepting new patients

Locations

1300 Jefferson Park Ave
Fl 4
Charlottesville, VA 22903
Phone (434) 924-5125

1204 W Main St
Charlottesville, VA 22903
Phone (434) 924-0123

1 Hospital Dr
Fl 4
Charlottesville, VA 22908
Phone (434) 243-6828

1215 Lee St
Fl 8
Charlottesvle, VA 22908
Phone (434) 924-2500

70 Medical Ctr Dr
Ste 203
Fishersville, VA 22939

70 Medical Center Cir
Ste 203
Fishersville, VA 22939
Phone (540) 932-5571

70 Medical Ctr Dr
Ste 203
Fishersville, VA 22939
Phone (540) 932-5771

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

201 16th Ave E
Seattle, WA 98112
Phone (206) 326-4545

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: jbenedetti235131@ghc.direct-ci.net

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1104938893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125226",
            "telephone_number": "206-326-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 16TH AVE E",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981125226",
            "telephone_number": "206-326-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "70 Medical Center Cir Ste 203",
            "address_purpose": "LOCATION",
            "city": "Fishersville",
            "state": "VA",
            "postal_code": "229392273",
            "country_code": "US",
            "telephone_number": "540-932-5571",
            "fax_number": "540-932-5772",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1204 W Main St",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229032824",
            "country_code": "US",
            "telephone_number": "434-982-6100",
            "fax_number": "434-982-0747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENEDETTI",
        "first_name": "JEREMY",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0121X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Plastic Surgery",
            "state": "VA",
            "license": "0101263196",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": "MD24934",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "ME99859",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "WA",
            "license": "MD60986017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "201 16th Ave E",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981125226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.