Jeffrey Green Bennion, M.D.

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

274201-1205 Issued in UT

Practice address

2245 N 400 E
Ste 301
North Logan, UT 84341-1892

Phone

(435) 753-7880

Fax

(435) 753-5845

NPI assigned

Sep 23, 2005

Last updated

Mar 7, 2023By 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: jgbennion@cvent.emadirect.md

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1396731469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 N 400 E",
            "address_2": "STE 301",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411892",
            "telephone_number": "435-753-7880",
            "fax_number": "435-753-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 N 400 E",
            "address_2": "STE 301",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411892",
            "telephone_number": "435-753-7880",
            "fax_number": "435-753-5845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2380 N 400 E",
            "address_2": "Suite #D",
            "address_purpose": "LOCATION",
            "city": "North Logan",
            "state": "UT",
            "postal_code": "843411749",
            "country_code": "US",
            "telephone_number": "435-753-7880 x208",
            "fax_number": "435-753-5845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNION",
        "first_name": "JEFFREY",
        "middle_name": "GREEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-03-07",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "UT",
            "license": "274201-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH CONTROLLED SUBSTANCE",
            "identifier": "274201-9915",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO STATE LICENSE",
            "identifier": "M-6924",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO BOARD OF PHARMACY",
            "identifier": "7054",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in North Logan, UT
• Providers in North Logan, UT by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.