Individual provider Active NPI

Bennicia Davis, PA-C

  • Medical Physician Assistant
  • Louisville, KY
National Provider Identifier
1356722854
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA1998 Issued in KY
Practice address
200 E Chestnut St
Suite 303
Louisville, KY 40202-1831
Phone
(502) 629-5552
Fax
(502) 629-3132
NPI assigned
Jun 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1998 KY Primary

Addresses

Primary practice location

200 E Chestnut St
Suite 303
Louisville, KY 40202-1831

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bdavis62781@bhkydirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150625000341 KY Practitioner - Physician Assistant 2062723562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Kentucky College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

1700 Nicholasville Rd
Lexington, KY 40503-1431

4071 Tates Creek Centre Dr
Suite 202
Lexington, KY 40517-3094
Phone (859) 260-4390

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA1998KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Apr 17, 2017 Accepting new patients
Community Medical Associates, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Apr 17, 2017 Accepting new patients

Locations

4071 Tates Creek Centre Dr
Ste 202
Lexington, KY 40517
Phone (859) 260-4390

1740 Nicholasville Rd
Lexington, KY 40503
Phone (859) 260-6100

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

200 E Chestnut St
Ste 303
Louisville, KY 40202
Phone (502) 629-5552

Organizations & group practices 6

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 1

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": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1356722854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E CHESTNUT ST",
            "address_2": "SUITE 303",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021831",
            "telephone_number": "502-629-5552",
            "fax_number": "502-629-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BENNICIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-11",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA1998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdavis62781@bhkydirect.com",
            "affiliation": "N",
            "address_1": "1740 Nicholasville Rd",
            "city": "Lexington",
            "state": "KY",
            "country_code": "US",
            "postal_code": "405031431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.