Individual provider Active NPI

Marian Benner, MD

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Bangor, ME
National Provider Identifier
1316018260
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
License
MD16834 Issued in ME
Practice address
360 Broadway
Bangor, ME 04401-3979
Phone
(207) 907-1550
Fax
(207) 907-3052
NPI assigned
Nov 13, 2006
Last updated
Feb 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X MD16834 ME Primary
Internal Medicine Physician 207R00000X MD16834 ME

Addresses

Primary practice location

360 Broadway
Bangor, ME 04401-3979

Mailing address

C/O St Marys Health System - Provider Enrollment
PO Box 7291
Lewiston, ME 04243-7291
Phone (207) 777-8560

Other identifiers 1

IdentifierTypeStateIssuer
528951300MedicaidME

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbenner613754@direct-prd.goodhelpconnections.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20050503000490 ME Practitioner - Undersea and Hyperbaric MedicinePractitioner - Internal MedicinePractitioner - Emergency Medicine 0143206086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Undersea and Hyperbaric MedicineAlso: Emergency Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph HospitalGroup PAC ID 6406766336, 197 clinicians

Practice addresses (Care Compare)

360 Broadway
Bangor, ME 04401-3979

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.58 of 100Reported as apm
Quality
83.17
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue27
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD16834MEMDUndersea and Hyperbaric Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Hospital CurrentSince Apr 6, 2005 Accepting new patients
Dresnick Sterling Emergency Physicians of Maryland PA Emergency Medicine Past Accepting new patients
Dresnick Sterling Emergency Physicians of Maryland PA Emergency Medicine Past Accepting new patients

Locations

360 Broadway
Bangor, ME 04401
Phone (207) 262-1703

360 Broadway
#L
Bangor, ME 04401
Phone (207) 262-1703

900 Broadway
Bangor, ME 04401
Phone (207) 907-3300

Interoperability endpoints

  • Direct secure messaging: mbenner1149424@direct.bsmhealth.org
  • Direct secure messaging: mbenner613754@direct-prd.goodhelpconnections.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1316018260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT",
            "address_2": "PO BOX 7291",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042437291",
            "telephone_number": "207-777-8560",
            "fax_number": "207-777-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013979",
            "telephone_number": "207-907-1550",
            "fax_number": "207-907-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNER",
        "first_name": "MARIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "ME",
            "license": "MD16834",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD16834",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528951300",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbenner613754@direct-prd.goodhelpconnections.org",
            "affiliation": "N",
            "address_1": "360 Broadway",
            "city": "Bangor",
            "state": "ME",
            "country_code": "US",
            "postal_code": "044013979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.