Eric Gust Benson, RN, FNP
Individual provider Active NPI Family Nurse Practitioner · Waterford, CA
NPI 1649527664 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1649527664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 13248 (CA)
- Practice address
- 12700 Welch St
Waterford, CA 95386-8765 - Phone
- (209) 874-2345
- Fax
- (209) 874-3926
- NPI assigned
- Aug 8, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201008000126 | CA | Order and Referring Only - Nurse Practitioner | 9335410455 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13248 | CA | MD | Clinical Social Worker |
| 492134 | CA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Valley Health Center | Past | Accepting new patients |
Interoperability endpoints
- eric.benson.p1@direct.cmcentersinc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 492134 | CA | |
| Family Nurse Practitioner | 363LF0000X | 13248 | CA | Yes |
Addresses
Primary practice location
12700 Welch St
Waterford, CA 95386-8765
Mailing address
434 E Fairmont Ave
Modesto, CA 95354-0207
Phone (209) 918-7033
Other providers in Waterford, CA
- Melissa Renee Barcelos
- Marissa Boire
- Charles C. Kim, D.D.S., Inc.
- Dennis Cook Jr.
- Tatianna Renee Dean
- Don Michael Endress M.D.
All providers in Waterford, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.