Mary C Dibenedetto, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

003057 Issued in GA

Practice address

3075 Governors Place Blvd Ste 120
Kettering, OH 45409-1332

Phone

(937) 424-2580

Fax

(937) 424-3581

NPI assigned

May 19, 2006

Last updated

Nov 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment
• Wellstar Medical Group, LLC

  dba WellStar Rheumatology Associates of Marietta

  • Rheumatology Physician
  • Marietta, GA
  • NPI 1114210127
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Atlanta Colon and Rectal Surgery, PA

  • Colon & Rectal Surgery Physician
  • Atlanta, GA
  • NPI 1356382865
  NPD (past)
• Georgia Cancer Specialists I, PC

  • Specialist
  • Atlanta, GA
  • NPI 1821076241
  NPD (past)
• Northside Respiratory Care

  • Specialist
  • Atlanta, GA
  • NPI 1770506966
  NPD (past)
• Wellstar Medical Group, LLC

  dba WellStar Pulmonary Medicine

  • Pulmonary Disease Physician
  • Marietta, GA
  • NPI 1639475270
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1538113295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 GOVERNORS PLACE BLVD",
            "address_2": "SUITE 210",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454091332",
            "telephone_number": "937-424-8258",
            "fax_number": "937-424-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 GOVERNORS PLACE BLVD STE 120",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454091332",
            "telephone_number": "937-424-2580",
            "fax_number": "937-424-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBENEDETTO",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "003057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1538113295",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hetal Desai, PA-C
• Judi L Desimio, MS, FNP-BC
• Kelly Renee Dewald, RPH
• Diana C Dey, CRNA
• Diane Carolan Stegman Psychotherapy LLC
• Janet Marie Dickens, LSW
• Rosetta L Dickey, CPRS
• Elizabeth M Diem, PA
• Leslie Dierckman
• Verity C Digel, PAC

• Medical Physician Assistant in Kettering, OH
• Providers in Kettering, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.

Verify at the official NPI Registry.