Robert L Benton

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

PCA55519820160831 Issued in MN

Practice address

5119 Gateway St SE Unit 304
Prior Lake, MN 55372-5537

Phone

(612) 638-8311

Fax

(612) 638-8311

NPI assigned

Jan 19, 2018

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516320000000",
    "number": "1164930558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5119 GATEWAY ST SE UNIT 304",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722167",
            "telephone_number": "612-638-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5119 GATEWAY ST SE UNIT 304",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553725537",
            "telephone_number": "612-638-8311",
            "fax_number": "612-638-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTON",
        "first_name": "ROBERT",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "MN",
            "license": "PCA55519820160831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Aide in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Home Health Aide in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; 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.