NPIMap

Individual provider Active NPI

Benigno Waldo A Dagan, MD

  • Internal Medicine Physician
  • Sumner, WA
National Provider Identifier
1235182122
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00036169 Issued in WA
Practice address
1420 Main St
Sumner, WA 98390
Phone
(253) 987-5156
Fax
(253) 987-5462
NPI assigned
May 19, 2006
Last updated
May 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD00036169 WA Primary

Addresses

Primary practice location

1420 Main St
Sumner, WA 98390

Mailing address

1420 Main St
Sumner, WA 98390
Phone (253) 987-5156

Other identifiers 6

IdentifierTypeStateIssuer
0185591OtherWAL & I PROVIDER NUMBER
911203494BPOtherWAKPS PROVIDER NUMBER
9869DAOtherWAREGENCE RIDER NUMBER
5496722OtherWAAETNA PROVIDER NUMBER
98390A015OtherWATRICARE PROVIDER NUMBER
2004507MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040629000055 WA Practitioner - Internal Medicine 2769468826 Reassigns benefits to 1 organization
Receives reassigned benefits from 1 practitioner
Practice locations: Sumner, WA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1420 Main St
Sumner, WA 98390-1810
Phone (253) 987-5156

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Internal Medicine CurrentSince Jan 1, 2008 Accepting new patients
Multicare Health System CurrentSince Jan 1, 2008 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Past Accepting new patients
Cornerstone Medical Clinic Internal Medicine PastSince Feb 1, 2010 Accepting new patients
Olympic Physicians P.L.L.C. Past Accepting new patients
Good Samaritan Community Healthcare Internal Medicine Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18131/brand/1/csg/1/fhir/r4
  • Direct secure messaging: wdaganmd6427@direct.multicare.org

Practitioners & affiliated clinicians

Practitioners 1

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.

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1235182122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 MAIN ST",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "98390",
            "telephone_number": "253-987-5156",
            "fax_number": "253-987-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 MAIN ST",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "98390",
            "telephone_number": "253-987-5156",
            "fax_number": "253-987-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGAN",
        "first_name": "BENIGNO WALDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00036169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I PROVIDER NUMBER",
            "identifier": "0185591",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KPS PROVIDER NUMBER",
            "identifier": "911203494BP",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER NUMBER",
            "identifier": "9869DA",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "5496722",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER NUMBER",
            "identifier": "98390A015",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2004507",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumner, WA

Sources for this page

Verify at the official NPI Registry.