NPIMap

Individual provider Active NPI

Kirk Bennett, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1194382077
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
62204 Issued in CA
Practice address
835 W University Dr
Mesa, AZ 85201-5555
Phone
(480) 664-6007
NPI assigned
May 25, 2019
Last updated
Jul 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9503 AZ
Physician Assistant 363A00000X 5601009199 MI
Physician Assistant 363A00000X 62204 CA Primary

Addresses

Primary practice location

835 W University Dr
Mesa, AZ 85201-5555

Mailing address

835 W University Dr
Mesa, AZ 85201-5555

Other practice location 1

259 Mack Ave
Detroit, MI 48201
Phone (313) 577-1716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, CA, OR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190807000928 MI Practitioner - Physician Assistant 9931436474 Reassigns benefits to 4 organizations
I20230524002670 CA Practitioner - Physician Assistant 9931436474 Reassigns benefits to 1 organization
I20240314004034 OR Practitioner - Physician Assistant 9931436474 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Independent Observation Physicians PLLCGroup PAC ID 3577603604, 138 clinicians
Independent Hospitalist Physicians PLLCGroup PAC ID 3971874090, 61 clinicians
Columbia Lutheran CharitiesGroup PAC ID 5294643359, shared by 8 NPIs, 110 clinicians

Practice addresses (Care Compare)

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-3000

1639 SE Ensign LN
Warrenton, OR 97146-7308
Phone (503) 338-4500

47601 Grand River Ave
Novi, MI 48374-1233
Phone (248) 465-4210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
62204CAMDOral and Maxillofacial Surgery (Dentist)
9503AZMDPhysical Therapist
5601009199MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Lutheran Charities CurrentSince Nov 11, 2025 Accepting new patients
Columbia Lutheran Charities CurrentSince Nov 11, 2025 Accepting new patients
Professional Emergency Care, PC Physician Assistant CurrentSince Dec 15, 2020 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jul 22, 2024 Accepting new patients
Columbia Lutheran Charities CurrentSince Nov 11, 2025 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Jul 22, 2024 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Honorhealth-Fastmed Ambulatory Holdings LLC Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2373

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

2158 Exchange St
Ste 107
Astoria, OR 97103
Phone (503) 338-4085

1639 SE Ensign Ln
Ste B103
Warrenton, OR 97146
Phone (503) 338-4500

Interoperability endpoints

  • Direct secure messaging: kbennett367260@direct.hfhs.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1558742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1194382077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 W UNIVERSITY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852015555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 W UNIVERSITY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852015555",
            "telephone_number": "480-664-6007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "259 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "48201",
            "country_code": "US",
            "telephone_number": "313-577-1716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "KIRK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-25",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9503",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009199",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.