Paul A Bennett, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-054875 Issued in IL

Practice address

374 E Grand Ave # 6740
Carbondale, IL 62901-3962

Phone

(618) 453-3311

Fax

(618) 453-4449

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southern Illinois University

  dba Community Nursing Services

  • Clinic/Center
  • E Saint Louis, IL
  • NPI 1306273776
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1366526600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 CHAUTAUQUA RD",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015241",
            "telephone_number": "618-457-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 E GRAND AVE # 6740",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013962",
            "telephone_number": "618-453-3311",
            "fax_number": "618-453-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "PAUL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-054875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Belisle, MS, BCBA
• Donna M Bell, DO
• Bellisima Laser Aesthetics and Wellness Clinic, L.L.C.
• Edgar Andres Bello Martinez, M.D.
• Dmitry Bendersky, PHARMACIST
• Rebecca Bennett, CPM
• Sharon K Bergfeld, R.PH.
• Whitney Berman, MSW,LSW
• Emily Ann Berry, PA-C
• Jennifer Besson

• Family Medicine Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.