Active NPI
Louise B Bennett, M.D.
- Family Medicine Physician
- Rochester, NY
National Provider Identifier
1194744854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 143254
- Practice address
- 322 Lake Ave
Rochester, NY 14608-1017 - Phone
- (585) 254-6480
- Fax
- (585) 254-1092
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 143254 | NY | Primary |
Addresses
Primary practice location
322 Lake Ave
Rochester, NY 14608-1017
Mailing address
322 Lake Ave
Rochester, NY 14608-1017
Phone (585) 254-6480
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P010143254 | Other | NY | BLUE CHOICE ROCHESTER |
| 080075250 | Other | NY | RAILROAD MEDICARE |
| 143254 | Medicaid | NY | |
| 100920BF | Other | NY | PREFERRED CARE |
| 01258268 | Medicaid | NY | |
| 6559 | Other | NY | BLUE CROSS ROCHESTER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143254 | NY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1194744854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 LAKE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146081017",
"telephone_number": "585-254-6480",
"fax_number": "585-254-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 LAKE AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146081017",
"telephone_number": "585-254-6480",
"fax_number": "585-254-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "LOUISE",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "143254",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE ROCHESTER",
"identifier": "P010143254",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080075250",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "143254",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "100920BF",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01258268",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS ROCHESTER",
"identifier": "6559",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.