Active NPI
John Charles Benitez, PH.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1225135841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 71-3304
- Practice address
- 405 N Wabash Ave
1814
Chicago, IL 60611-3591 - Phone
- (312) 245-5269
- Fax
- (312) 527-0849
- NPI assigned
- Sep 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 71-3304 | IL | Primary |
Addresses
Primary practice location
405 N Wabash Ave
1814
Chicago, IL 60611-3591
Mailing address
405 N Wabash Ave
1814
Chicago, IL 60611-3591
Phone (312) 245-5269
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jun 18, 2015 through Jun 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71-3304 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225135841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 N WABASH AVE",
"address_2": "1814",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113591",
"telephone_number": "312-245-5269",
"fax_number": "312-527-0849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 N WABASH AVE",
"address_2": "1814",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113591",
"telephone_number": "312-245-5269",
"fax_number": "312-527-0849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENITEZ",
"first_name": "JOHN",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "71-3304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.