Active NPI
Benton Clay Kinney, PA
- Physician Assistant
- Redding, CA
National Provider Identifier
1447469085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16208
- Practice address
- 2865 Churn Creek Rd
Suite a
Redding, CA 96002-1117 - Phone
- (530) 646-7269
- Fax
- (530) 275-2201
- NPI assigned
- May 21, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16208 | CA | Primary |
Addresses
Primary practice location
2865 Churn Creek Rd
Suite a
Redding, CA 96002-1117
Mailing address
1999 Salzburg TRL
Redding, CA 96003-9334
Phone (530) 209-5978
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006799550 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA16208 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rolling Hills Clinic | Past | Accepting new patients |
Interoperability endpoints
- benton.kinney.p1@direct.lcthc.nextgenshare.com
Organizations & group practices 3
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.
-
- Psychiatry Physician
- Redding, CA
- NPI 1073919171
-
- General Practice Physician
- Yreka, CA
- NPI 1730279423
-
- Federally Qualified Health Center (FQHC)
- Red Bluff, CA
- NPI 1679988950
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416960000000",
"number": "1447469085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1999 SALZBURG TRL",
"city": "REDDING",
"state": "CA",
"postal_code": "960039334",
"telephone_number": "530-209-5978",
"fax_number": "530-275-2201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2865 CHURN CREEK RD",
"address_2": "SUITE A",
"city": "REDDING",
"state": "CA",
"postal_code": "960021117",
"telephone_number": "530-646-7269",
"fax_number": "530-275-2201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNEY",
"first_name": "BENTON",
"middle_name": "CLAY",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2014-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA16208",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "006799550",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; 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.