Randall C Bennett, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2262 Issued in FL

Practice address

9570 Regency Square Blvd
Jacksonville, FL 32225-9103

Phone

(904) 725-7100

Fax

(904) 720-0059

NPI assigned

Apr 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14607/brand/1/csg/1/fhir/r4

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.

• Center for Medicine and Psychiatry

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1528010923
  NPD (past)
• Mohamed Saleh Dispensary

  • Non-Pharmacy Dispensing Site
  • Jacksonville, FL
  • NPI 1518130590
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185321600000",
    "number": "1134344211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12079 BLACKFOOT TRL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322233233",
            "telephone_number": "904-292-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9570 REGENCY SQUARE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322259103",
            "telephone_number": "904-725-7100",
            "fax_number": "904-720-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "RANDALL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA2262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Bennett, ARNP
• Lishon Bennett
• Pamela K Bennett, APRN
• Peggie Bennett
• Ramona Bennett
• Roosevelt Bennett Jr., AA-C
• Bennie Clark Jr DMD PA
• George S Bennitt, DDS
• Joanna Benoit, LMT
• Molly Margaret Benolken, MD

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; 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.