NPIMap

Individual provider Active NPI

Michael T Bennett, PA-C

  • Physician Assistant
  • Worcester, MA
National Provider Identifier
1396724563
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1721 Issued in MA
Practice address
55 Lake Ave N
Division of Neurosurgery
Worcester, MA 01655-0002
Phone
(508) 334-7042
Fax
(508) 334-5074
NPI assigned
Jan 16, 2006
Last updated
Nov 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1721 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Division of Neurosurgery
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-5348
Phone (800) 225-8885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040302000116 MA Practitioner - Physician Assistant 3476440827 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holyoke Medical Center IncGroup PAC ID 2163419383, 202 clinicians

Practice addresses (Care Compare)

10 Hospital Dr
Suite 203
Holyoke, MA 01040-6643
Phone (413) 536-5814

11 Hospital Dr
Holyoke, MA 01040-6601
Phone (413) 532-1411

5 Hospital Dr
FL 1
Holyoke, MA 01040-6601
Phone (413) 534-2582

575 Beech St
Holyoke, MA 01040-2223

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1721MAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Riverbend Medical Group, Inc CurrentSince Dec 5, 2021 Accepting new patients
Western Mass Physician Associates Inc CurrentSince Nov 1, 2024 Accepting new patients
Holyoke Medical Center, Inc. CurrentSince Apr 3, 2023 Accepting new patients
Riverbend Medical Group, Inc. CurrentSince Dec 5, 2021 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Nov 15, 2010 Accepting new patients
Caritas Medical Group, Inc. Past Accepting new patients
Steward Medical Group, Inc Past Accepting new patients
Mercy Inpatient Medical Associates Inc. Past Accepting new patients
Mwa,PC Past Accepting new patients
Western Mass Physician Associates Inc Past Accepting new patients

Locations

262 New Ludlow Rd
Chicopee, MA 01020
Phone (413) 535-4714

10 Hospital Dr
Ste 306
Holyoke, MA 01040
Phone (413) 539-6830

575 Beech St
Ste 402
Holyoke, MA 01040
Phone (413) 534-2820

40 Wright St
Palmer, MA 01069
Phone (413) 284-5210

271 Carew St
Springfield, MA 01104
Phone (413) 748-9000

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Organizations & group practices 12

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.

Hospital & facility affiliations 3

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": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1396724563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415348",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "address_2": "DIVISION OF NEUROSURGERY",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-7042",
            "fax_number": "508-334-5074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.