Ethan R Benore, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6154 Issued in OH

Practice address

2801 MLK Jr Dr
Cleveland, OH 44104-3815

Phone

(216) 448-6253

NPI assigned

Jul 11, 2006

Last updated

Nov 12, 2021By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ebenore61722@direct.ccf.org

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.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment NPD
• Euclid Hospital Cleveland Clinic Health System

  dba cleveland clinic foundation

  • General Acute Care Hospital
  • Euclid, OH
  • NPI 1457403016
  NPD

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1629002951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 MLK JR DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043815",
            "telephone_number": "216-448-6253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 MLK JR DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043815",
            "telephone_number": "216-448-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENORE",
        "first_name": "ETHAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "6154",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OH",
            "license": "6154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2606326",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael S. Benninger, M.D.
• Tara Bennington
• John Charles Bennison, DO
• Michaela Kathryn Beno
• Susan Benoit, RN
• Jessica Benovic, APRN
• Albatoul Bensitel, M.D.
• Angela Benson
• Bryan Benson, MD, PHD
• Daniel Towry Benson

• Clinical Child & Adolescent Psychologist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; 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.