Individual provider Active NPI

Benjamin Tanner, PA-C

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1487076402
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
901 Rancho LN Ste 135
Las Vegas, NV 89106-3826
Phone
(702) 383-1958
Fax
(702) 366-8545
NPI assigned
Jan 9, 2014
Last updated
Jan 9, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

901 Rancho LN Ste 135
Las Vegas, NV 89106-3826

Mailing address

901 Rancho LN Ste 135
Las Vegas, NV 89106-3826
Phone (702) 383-1958

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140429002206 NV Practitioner - Physician Assistant 4082847967 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Physician Assistant CurrentSince Jun 1, 2017 Accepting new patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Nov 7, 2024 Accepting new patients
Eds-I Homansky Practices of Nevada PC Physician Assistant CurrentSince Nov 7, 2024 Accepting new patients
Carefirst Urgent Care, LLC PastSince Aug 9, 2020 Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

657 N Town Center Dr
Las Vegas, NV 89144
Phone (702) 233-7571

360 S Lola Ln
Pahrump, NV 89048
Phone (775) 751-7500

1511 Oppio Ranch Pkwy
Sparks, NV 89436
Phone (775) 567-5400

Organizations & group practices 7

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": "1389225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389225600000",
    "number": "1487076402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 RANCHO LN STE 135",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063826",
            "telephone_number": "702-383-1958",
            "fax_number": "702-366-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 RANCHO LN STE 135",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063826",
            "telephone_number": "702-383-1958",
            "fax_number": "702-366-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "BENJAMIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.