Robert Benavides Jr., ED.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 11363 Issued in CA

Practice address

2455 Bennett Valley Rd
Suite 210 C
Santa Rosa, CA 95404-5663

Phone

(707) 542-2081

Fax

(707) 542-2082

NPI assigned

Nov 30, 2005

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Santa Rosa Community Health Centers

  dba Caritas Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1467180430

  Corporate Director

  CMS ownership
• Santa Rosa Community Health Centers

  dba Bridge Health Services

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1518345511

  Corporate Director

  CMS ownership
• Santa Rosa Community Health Centers

  dba Vista Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1578631172

  Corporate Director

  CMS ownership
• Santa Rosa Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1780195255

  Corporate Director

  CMS ownership

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.

• Robert Benavides Jr.

  • Psychologist
  • Santa Rosa, CA
  • NPI 1386674059
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1487638714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 BENNETT VALLEY RD",
            "address_2": "SUITE 210 C",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045663",
            "telephone_number": "707-542-2081",
            "fax_number": "707-542-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 BENNETT VALLEY RD",
            "address_2": "SUITE 210 C",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045663",
            "telephone_number": "707-542-2081",
            "fax_number": "707-542-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENAVIDES JR.",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 11363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa Lynn Beltran del Rio, CMT
• Jaime Mauricio Beltran Jr.
• Katherine Beltran
• Natalie Renee Beltran
• Amanda Rose Bemis, FNP
• Jeffrey Bencini, PHARMD
• Itzel Benitez Benitez
• Bennett Valley Icf DDH Inc
• Bennett Valley Union Elem
• David W. Bennett, MD

• Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.