Wayne David Leroy Bentham, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

68407 Issued in MN

Practice address

3640 Talmage Cir Ste 216
Vadnais Heights, MN 55110-7100

Phone

(952) 431-5330

Fax

(952) 431-5334

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WI, MN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Howard University College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Danielle Golden, Crna, PAGroup PAC ID 6305934597, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wbentham@yourcarecommunity.org
• Direct secure messaging: wbentham189101@direct.thedacare.org

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.

• Danielle Golden, Crna, PA

  • Adult Mental Health Clinic/Center
  • Vadnais Heights, MN
  • NPI 1598954687

  MN, Psychiatry, WI

  Medicare reassignment Care Compare group NPD
• Lake Area Dermatology PA

  • Dermatology Physician
  • Vadnais Heights, MN
  • NPI 1710270921
  NPD (past)

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1609952407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR STE 216",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551107100",
            "telephone_number": "952-431-5330",
            "fax_number": "951-431-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR STE 216",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551107100",
            "telephone_number": "952-431-5330",
            "fax_number": "952-431-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTHAM",
        "first_name": "WAYNE",
        "middle_name": "DAVID LEROY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "WI",
            "license": "62533-20",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "62533-20",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "68407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0186104",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609952407",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214692001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609952407",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL ID-MOTOR VEHICLE ID",
            "identifier": "276890",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Bader, PHARM D
• Kaitlyn Michelle Bader, PHARMD
• Jase Bakker
• Ryan M Bastyr, PT
• Catherine S. Bedford, M.D.
• Kristin Bentz, CNS
• Emily Dawn Berglund, MA, CCC-SLP
• Yafet W Berhane
• Abby Katrina Bernstein, PA-C
• Michaela Bertsch, PA-C

• All providers in Vadnais Heights, MN
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.
• 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.