Active NPI
Vincent Carl Bentley, MD
- Family Medicine Physician
- Fort Gordon, GA
National Provider Identifier
1477535565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 033798
- Practice address
- 300 East Hospital Road
Fort Gordon, GA 30905 - Phone
- (706) 787-9355
- Fax
- (706) 787-7201
- NPI assigned
- Nov 16, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 033798 | GA | Primary |
Addresses
Primary practice location
300 East Hospital Road
Fort Gordon, GA 30905
Mailing address
300 East Hospital Road
Fort Gordon, GA 30905
Phone (706) 787-9355
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033798 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492041600000",
"number": "1477535565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 EAST HOSPITAL ROAD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-9355",
"fax_number": "706-787-7201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 EAST HOSPITAL ROAD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-9355",
"fax_number": "706-787-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENTLEY",
"first_name": "VINCENT",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2017-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "033798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; 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.