Active NPI
Thomas Omar Bennett, M.D.
- Specialist
- Merrillville, IN
National Provider Identifier
1427051911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 01030607A
- Practice address
- 8679 Connecticut St
Ste a
Merrillville, IN 46410-6383 - Phone
- (219) 769-9022
- Fax
- (219) 769-1918
- NPI assigned
- May 27, 2005
- Last updated
- Mar 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 01030607A | IN | Primary |
Addresses
Primary practice location
8679 Connecticut St
Ste a
Merrillville, IN 46410-6383
Mailing address
8679 Connecticut St
Ste a
Merrillville, IN 46410-6383
Phone (219) 769-9022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100167860 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01030607A | IN | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Retina Vitreous Associates, PC | Specialist | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395792000000",
"number": "1427051911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8679 CONNECTICUT ST",
"address_2": "STE A",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464106383",
"telephone_number": "219-769-9022",
"fax_number": "219-769-1918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8679 CONNECTICUT ST",
"address_2": "STE A",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464106383",
"telephone_number": "219-769-9022",
"fax_number": "219-769-1918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "THOMAS",
"middle_name": "OMAR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2014-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IN",
"license": "01030607A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100167860",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.