NPIMap

Organization Active NPI

Dana R Bennett MD PC

  • Family Medicine Physician
  • Pueblo West, CO
National Provider Identifier
1407063563
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21659 Issued in CO
Legal business name
DANA R BENNETT MD PC
Practice address
121 S Crescent Dr
Pueblo West, CO 81007-5433
Phone
(719) 547-3924
Fax
(719) 547-8368
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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

Authorized official

Name
Mrs. Patti F Bennett
Title
Office MGR
Phone
(719) 547-3924

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 21659 CO Primary

Addresses

Primary practice location

121 S Crescent Dr
Pueblo West, CO 81007-5433

Mailing address

121 S Crescent Dr
Pueblo West, CO 81007-5433
Phone (719) 547-3924

Other identifiers 1

IdentifierTypeStateIssuer
04006540MedicaidCO

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1407063563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S CRESCENT DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075433",
            "telephone_number": "719-547-3924",
            "fax_number": "719-547-8368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S CRESCENT DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075433",
            "telephone_number": "719-547-3924",
            "fax_number": "719-547-8368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANA R BENNETT MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "PATTI",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "719-547-3924",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "21659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04006540",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo West, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.