Active NPI
Jonathan Alexander Benavides, ATC
- Athletic Trainer
- Corpus Christi, TX
National Provider Identifier
1336555895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000017616
- Practice address
- 6506 Lazy Willow Court
Corpus Christi, TX 78412-4857 - Phone
- (361) 236-9800
- NPI assigned
- Jul 5, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000017616 | TX | Primary |
Addresses
Primary practice location
6506 Lazy Willow Court
Corpus Christi, TX 78412-4857
Mailing address
6506 Lazy Willow Court
Corpus Christi, TX 78412-4857
Phone (361) 236-9800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000017616 | Other | TX | ATHLETIC TRAINER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000017616 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404518400000",
"number": "1336555895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6506 LAZY WILLOW COURT",
"city": "CORPUS CHRISTI",
"state": "TX",
"postal_code": "784124857",
"telephone_number": "361-236-9800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6506 LAZY WILLOW COURT",
"city": "CORPUS CHRISTI",
"state": "TX",
"postal_code": "784124857",
"telephone_number": "361-236-9800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDES",
"first_name": "JONATHAN",
"middle_name": "ALEXANDER",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-05",
"last_updated": "2014-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "2000017616",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "2000017616",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corpus Christi, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.