Randall Bennett

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1720 18TH Ave
Lewiston, ID 83501-4047

Phone

(208) 746-4097

Fax

(208) 746-2294

NPI assigned

Oct 28, 2024

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1194547422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 18TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014047",
            "telephone_number": "208-746-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 18TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014047",
            "telephone_number": "208-746-4097",
            "fax_number": "208-746-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "RANDALL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa M Bell, OD
• Brianne Bender
• Gregory John Bengtson, D.D.S.
• Brandy L Benner, BSW
• Keriann Marie Bennett, PHARMD
• Sara Light Bennett, LCPC
• Julie Benton, LMFT
• Mark Wynn Berger, L.C.S.W.
• Nancy Berkheiser, M.D.
• Bertha Whitney

• All providers in Lewiston, ID
• Case Manager/Care Coordinator in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.