Individual provider Active NPI

Jason B. Bennett, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Grand Rapids, MI
National Provider Identifier
1295757631
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
4301076635 Issued in MI
Practice address
770 Kenmoor Ave SE Ste 301
Grand Rapids, MI 49546-8621
Phone
(616) 290-1876
Fax
(616) 290-1877
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 4301076635 MI Primary

Addresses

Primary practice location

770 Kenmoor Ave SE Ste 301
Grand Rapids, MI 49546-8621

Mailing address

770 Kenmoor Ave SE Ste 301
Ste 301
Grand Rapids, MI 49546-8621
Phone (616) 290-1876

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907001211 MI Practitioner - Obstetrics/Gynecology 2668448028 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Michigan State University College of Human Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians
Bennett Institute for Urogynecology and Incontinence PCGroup PAC ID 8729462619, 4 clinicians

Practice addresses (Care Compare)

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

770 Kenmoor Ave SE
Suite 301
Grand Rapids, FL 49546-8621

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
  • Charlevoix Area Hospital Hospital, Charlevoix, MI, CCN 231322

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301076635MIMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bennett Institute for Urogynecology and Incontinence PC Urogynecology and Reconstructive Pelvic Surgery CurrentSince Jul 18, 2022 Accepting new patients
Oam Surgery Center at Midtowne, LLC PastSince Apr 30, 2003 Accepting new patients

Locations

770 Kenmoor Ave SE
Ste 301
Grand Rapids, MI 49546
Phone (616) 252-4407

5060 Cascade Rd SE
Ste C-1
Grand Rapids, MI 49546
Phone (616) 255-9521

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1295757631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 KENMOOR AVE SE STE 301",
            "address_2": "STE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468621",
            "telephone_number": "616-290-1876",
            "fax_number": "616-290-1876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KENMOOR AVE SE STE 301",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468621",
            "telephone_number": "616-290-1876",
            "fax_number": "616-290-1877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JASON",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "MI",
            "license": "4301076635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.