Patrise Bennett, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

15488 Issued in MS

Practice address

5606 Old Canton Rd
Jackson, MS 39211-4217

Phone

(601) 957-3333

Fax

(601) 957-3334

NPI assigned

Jul 24, 2006

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• First Intermed Corporation

  • Family Medicine Physician
  • Brandon, MS
  • NPI 1932133931
  NPD (past)
• Premier Medical Group of Mississippi LLC

  • Clinic/Center
  • Jackson, MS
  • NPI 1548219884
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407878747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5606 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-957-3333",
            "fax_number": "601-957-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5606 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-957-3333",
            "fax_number": "601-957-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "PATRISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "15488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0118967",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Freeman T Bennett, M.D.
• James Grady Bennett Jr., MD
• James L Bennett, DMD
• Jamiya Lashonti Bennett
• Kenneth R. Bennett, MD
• Ted Bennett, PH.D.
• Tina Renee Bennett, FNP-BC
• Jeremy James Benoit, D.O.
• James Michael Bensler, MD
• Brandon Benson

• Family Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.