Active NPI
Benjamin Jared Bauer, M.D.
- Family Medicine Physician
- Pawtucket, RI
National Provider Identifier
1629399951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- LP01903
- Practice address
- 111 Brewster St
FCC a
Pawtucket, RI 02860-4474 - Phone
- (401) 729-3469
- Fax
- (401) 729-2541
- NPI assigned
- Jun 22, 2010
- Last updated
- Jun 22, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | LP01903 | RI | Primary |
Addresses
Primary practice location
111 Brewster St
FCC a
Pawtucket, RI 02860-4474
Mailing address
111 Brewster St
FCC a
Pawtucket, RI 02860-4474
Phone (401) 729-3469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP01903 | RI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277164800000",
"number": "1629399951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 BREWSTER ST",
"address_2": "FCC A",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028604474",
"telephone_number": "401-729-3469",
"fax_number": "401-729-2541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 BREWSTER ST",
"address_2": "FCC A",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028604474",
"telephone_number": "401-729-3469",
"fax_number": "401-729-2541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUER",
"first_name": "BENJAMIN",
"middle_name": "JARED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-22",
"last_updated": "2010-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "RI",
"license": "LP01903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.