NPIMap

Organization Active NPI

Bennett Surgery Centers a Medical Corp

  • Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1174679260
Registry record updated Jan 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BENNETT SURGERY CENTERS A MEDICAL CORP
Practice address
1301 20TH St
Suite 570
Santa Monica, CA 90404
Phone
(310) 315-0171
Fax
(310) 828-6647
NPI assigned
Jan 25, 2007
Last updated
Jan 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2010

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

Authorized official

Name
Richard Gary Bennett, MDNPI 1760416648
Title
Owner
Phone
(310) 315-0171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1301 20TH St
Suite 570
Santa Monica, CA 90404

Mailing address

1301 20TH St
Suite 570
Santa Monica, CA 90404
Phone (310) 315-0171

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263772800000",
    "number": "1174679260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 20TH ST",
            "address_2": "SUITE 570",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-315-0171",
            "fax_number": "310-828-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 20TH ST",
            "address_2": "SUITE 570",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-315-0171",
            "fax_number": "310-828-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT SURGERY CENTERS A MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2010-01-18",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-315-0171",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2010; 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.