Bennett Wayne Pafford, M.D.
Individual provider Active NPI Internal Medicine Physician · La Conner, WA
NPI 1255568366 · NPPES record last updated May 23, 2024
Key facts
- NPI
- 1255568366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD61304014 (WA)
- Practice address
- 528 Myrtle Street
La Conner, WA 98257 - Phone
- (360) 446-3136
- Fax
- (360) 466-0107
- NPI assigned
- Jun 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- East Tennessee State University Quillen College of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Select Outpatient Services Inc
Select Rehabilitation, LLC
Practice addresses (Care Compare)
2600 Compass Rd
Glenview, IL 60026-8001
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240612001545 | WA | Practitioner - Internal Medicine | 0749455731 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD61304014 | WA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wyoming Medical Associates, LLC | Current |
Accepting new patients | |
| Optum Care Washington PLLC | Family Medicine | Current | Accepting new patients |
| Optum Care Washington PLLC | Current |
Accepting new patients | |
| Optum Care Washington PLLC | Family Medicine | Current |
Accepting new patients |
Locations
1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903
1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299
51 Town Center Dr
Ste 120
Gillette, WY 82718
Phone (307) 682-9962
1013 E Boxelder Rd
Ste 210
Gillette, WY 82718
Phone (307) 363-4133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD61304014 | WA | Yes |
Addresses
Primary practice location
528 Myrtle Street
La Conner, WA 98257
Mailing address
PO Box 5127
Everett, WA 98206-5127
Phone (254) 258-3900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A114715 | Other | CA | STATE LICENSE |
Other providers in La Conner, WA
- Cynthia Melisa McCannel
- Sarah Miller
- Lindsey Monica Montileaux Mabbutt
- Thanh Nguyen
- Leah Reiko Nystrom
- Reidun E Pederson
- Rene Amelia Pinkham
- Pure Joy Naturopathic Medicine
- Larry Joseph Quesnell
- Yolanda Grado Quevedo
All providers in La Conner, WA · Internal Medicine Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.