Benjamin Corey Fernandez, C-AA, DPT

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

AA472 Issued in FL

Practice address

1225 Airport Rd
Destin, FL 32541-2909

Phone

(850) 650-7606

Fax

(850) 337-1698

NPI assigned

Jul 25, 2012

Last updated

Jan 20, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Dynamics LLCGroup PAC ID 3779832530, 883 clinicians

Destin Anesthesia, LLCGroup PAC ID 9830158500, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts, Master of Science

State licenses

Practice roles

Locations

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.

• Anesthesia Dynamics LLC

  • Anesthesiology Physician
  • Bradenton, FL
  • NPI 1073001012
  Medicare reassignment Care Compare group NPD
• Destin Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Destin, FL
  • NPI 1891726394
  Medicare reassignment Care Compare group NPD
• Womens Manual Physical Therapy LLC

  dba FYZICAL Therapy and Balance Center

  • Physical Therapist
  • Crestview, FL
  • NPI 1013221894
  NPD (past)

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1356697577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412909",
            "telephone_number": "850-650-7606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412909",
            "telephone_number": "850-650-7606",
            "fax_number": "850-337-1698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4113 NW 6th St Ste C",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326090731",
            "country_code": "US",
            "telephone_number": "352-376-6300",
            "fax_number": "352-372-0661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326100254",
            "country_code": "US",
            "telephone_number": "352-273-8610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "BENJAMIN",
        "middle_name": "COREY",
        "credential": "C-AA, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-25",
        "last_updated": "2021-01-20",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT27491",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y0CP4",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01240342",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101045800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiologist Assistant in Destin, FL
• Providers in Destin, FL by specialty
• Anesthesiologist Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.