Scott D. Benjamin, D.D.S.

Key facts

NPI

1376540450

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

033878 (NY)

Practice address

60 Union St
Sidney, NY 13838-1430

Phone

(607) 563-2333

Fax

(607) 563-8946

NPI assigned

Jul 5, 2005

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Scott D Benjamin DDS PC General Practice Dentistry · Sidney, NY · NPI 1295777688
  NPD (past) Authorized official GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Opted out of Medicare

Yes, effective Feb 8, 2019 through Feb 8, 2027

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 22, 2010.

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277164800000",
    "number": "1376540450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1863 CRYSTAL LAKE RD",
            "city": "HANCOCK",
            "state": "NY",
            "postal_code": "137831915",
            "telephone_number": "607-467-4456",
            "fax_number": "607-467-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 UNION ST",
            "city": "SIDNEY",
            "state": "NY",
            "postal_code": "138381430",
            "telephone_number": "607-563-2333",
            "fax_number": "607-563-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENJAMIN",
        "first_name": "SCOTT",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2010-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "033878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00575475",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Sidney, NY · General Practice Dentistry in New York