Active NPI
Cody Matney Benavidez, PA-C
- Physician Assistant
- Fort Bliss, TX
National Provider Identifier
1487363065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 11335 SSG Sims St
Fort Bliss, TX 79918 - Phone
- (915) 742-1261
- NPI assigned
- Nov 22, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | |||
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
11335 SSG Sims St
Fort Bliss, TX 79918
Mailing address
11335 SSG Sims St
Soldier Care
Fort Bliss, TX 79918
Phone (915) 742-1261
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1487363065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11335 SSG SIMS ST",
"address_2": "SOLDIER CARE",
"city": "FORT BLISS",
"state": "TX",
"postal_code": "79918",
"telephone_number": "915-742-1261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11335 SSG SIMS ST",
"city": "FORT BLISS",
"state": "TX",
"postal_code": "79918",
"telephone_number": "915-742-1261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDEZ",
"first_name": "CODY",
"middle_name": "MATNEY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-22",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bliss, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.