NPIMap

Individual provider Active NPI

Brock Tanner Bennett, MD

  • Vascular Surgery Physician
  • Medford, OR
National Provider Identifier
1578092193
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD218720 Issued in OR
Practice address
520 Medical Center Dr Ste 300
Medford, OR 97504-4316
Phone
(541) 930-8907
Fax
(541) 245-4820
NPI assigned
Jun 7, 2017
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X MD218720 OR
Vascular Surgery Physician 2086S0129X MD218720 OR Primary

Addresses

Primary practice location

520 Medical Center Dr Ste 300
Medford, OR 97504-4316

Mailing address

520 Medical Center Dr Ste 300
Medford, OR 97504-4316
Phone (541) 930-8907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240807003076 OR Practitioner - Vascular SurgeryPractitioner - General Surgery 5890067664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of Arizona College of Medicine - Phoenix, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oregon Surgical Specialists PCGroup PAC ID 4789589540, 21 clinicians

Practice addresses (Care Compare)

520 Medical Ctr Dr
Suite 300
Medford, OR 97504-4316
Phone (541) 930-8907

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy18
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Varicose vein removal21
Leg revascularization (restoring blood flow)14
Removal of tissue12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD218720ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Surgical Specialists PC Surgery CurrentSince Jul 25, 2024 Accepting new patients
Asante Past Accepting new patients

Locations

520 Medical Center Dr
Ste 300
Medford, OR 97504
Phone (503) 779-0837

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1578092193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DR STE 300",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044316",
            "telephone_number": "541-930-8907",
            "fax_number": "541-245-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DR STE 300",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044316",
            "telephone_number": "541-930-8907",
            "fax_number": "541-245-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "BROCK",
        "middle_name": "TANNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD218720",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "OR",
            "license": "MD218720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.