Individual provider Active NPI

Barbara E Bennethum, CRNA

  • Certified Registered Nurse Anesthetist
  • Reading, PA
National Provider Identifier
1265535397
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN192173L Issued in PA
Practice address
Sixth and Spruce Streets
Reading, PA 19612-6052
Phone
(610) 988-5089
Fax
(610) 988-5135
NPI assigned
Sep 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN192173L PA Primary

Addresses

Primary practice location

Sixth and Spruce Streets
Reading, PA 19612-6052

Mailing address

1122 Street Rd
Ste 204
Southampton, PA 18966-4218
Phone (215) 949-3100

Other identifiers 2

IdentifierTypeStateIssuer
22-1994560OtherPAHEALTH NET TRICARE
50077117OtherPACAPITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040123000362 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577465129 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Medical Group P CGroup PAC ID 1355247180, 105 clinicians

Practice addresses (Care Compare)

1001 James Dr
Leesport, PA 19533-8866
Phone (484) 284-9500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN192173LPAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Medical Group P C CurrentSince Nov 1, 2023 Accepting new patients
Professional Anesthesia Services of North America P.C. Nurse Anesthetist, Certified Registered CurrentSince Nov 10, 2019 Accepting new patients
Integrated Medical Group P C Current Accepting new patients
Integrated Medical Group, P.C. CurrentSince Nov 1, 2023 Accepting new patients
Clinical Pain Management Associates, PC Past Accepting new patients

Locations

2310 Highland Ave
Bethlehem, PA 18020
Phone (610) 691-4300

1001 James Dr
Leesport, PA 19533
Phone (215) 237-2103

82 Tunnel Rd
Pottsville, PA 17901
Phone (570) 622-5455

48 Tunnel Rd
Ste 104
Pottsville, PA 17901
Phone (570) 622-5555

48 Tunnel Rd
Ste 205
Pottsville, PA 17901
Phone (570) 622-1400

48 Tunnel Rd
Ste 203
Pottsville, PA 17901
Phone (570) 622-5455

100 E Lancaster Ave
Ste 158
Wynnewood, PA 19096
Phone (484) 206-5800

1280 Broadcasting Rd
Wyomissing, PA 19610
Phone (215) 949-3100

2752 Century Blvd
Wyomissing, PA 19610
Phone (610) 378-8800

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1265535397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 STREET RD",
            "address_2": "STE 204",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189664218",
            "telephone_number": "215-949-3100",
            "fax_number": "215-355-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SIXTH AND SPRUCE STREETS",
            "city": "READING",
            "state": "PA",
            "postal_code": "196126052",
            "telephone_number": "610-988-5089",
            "fax_number": "610-988-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETHUM",
        "first_name": "BARBARA",
        "middle_name": "E",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN192173L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET TRICARE",
            "identifier": "22-1994560",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS, KEYSTONE CENTRAL, SENIOR BLUE",
            "identifier": "50077117",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reading, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.