Individual provider Active NPI

Joan Bennett, PA

  • Physician Assistant
  • Paoli, PA
National Provider Identifier
1609822436
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA002787L Issued in PA
Practice address
255 W Lancaster Ave
Paoli, PA 19301-1763
Phone
(610) 648-1000
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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 MA002787L PA Primary

Addresses

Primary practice location

255 W Lancaster Ave
Paoli, PA 19301-1763

Mailing address

255 W Lancaster Ave
Paoli, PA 19301-1763
Phone (610) 648-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20051012000551 PA Practitioner - Physician Assistant 7911922547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of the Main Line P CGroup PAC ID 9931097193, 80 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Wynewood, PA 19096-3450
Phone (484) 476-2263

101 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3120
Phone (484) 337-4371

1068 W Baltimore Pike
Media, PA 19063-5104
Phone (484) 227-3005

120 Valley Green LN
King of Prussia, PA 19406-2079
Phone (866) 225-5654

130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3121
Phone (484) 337-4123

154 Exton Square Mall
Exton, PA 19341-2440
Phone (484) 565-8590

1991 Sproul Rd
Broomall, PA 19008-3512
Phone (484) 476-3700

255 W Lancaster Ave
Paoli, PA 19301-1763
Phone (484) 565-1596

3855 W Chester Pike
Newton Square, PA 19073-2304
Phone (484) 337-6149

599 Arcola Rd
Collegeville, PA 19426-3954
Phone (484) 565-8430

Hospital & facility affiliations

  • Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
  • Paoli Hospital Hospital, Paoli, PA, CCN 390153
  • Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
  • Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA002787LPAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare PastSince Jul 31, 2010 Accepting new patients
Cardiovascular Group LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1609822436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-648-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-648-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JOAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA002787L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paoli, PA

Sources for this page

Verify at the official NPI Registry.