Active NPI
Robert Emery Benowicz, MD
- Pediatrics Physician
- Bozeman, MT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0600003375
- Practice address
- 408 W Cleveland St
Bozeman, MT 59715-5120 - Phone
- (503) 319-3044
- NPI assigned
- Mar 13, 2007
- Last updated
- Aug 2, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0600003375 | VT | Primary |
Addresses
Primary practice location
408 W Cleveland St
Bozeman, MT 59715-5120
Mailing address
17230 Lake Haven Dr
Lake Oswego, OR 97035-6514
Phone (503) 319-3044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0600003375 | VT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Pediatrics | Current | Accepting new patients |
| Public Hospital Dist No 1 Skagit | Past | Accepting new patients | |
| Peacehealth | Past | Accepting new patients |
Locations
3015 Squalicum Pkwy
Ste 100
Bellingham, WA 98225
Phone (360) 715-4186
4545 Cordata Pkwy
Bellingham, WA 98226
Phone (360) 752-5646
1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253
Interoperability endpoints
- rbenowicz62952@skagit.direct-ci.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba PeaceHealth Medical Group
- Internal Medicine Physician
- Bellingham, WA
- NPI 1356309553
Pediatrics
-
dba Skagit Valley Hospital
- General Acute Care Hospital
- Mount Vernon, WA
- NPI 1053357244
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375401600000",
"number": "1669505335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17230 LAKE HAVEN DR",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970356514",
"telephone_number": "503-319-3044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 W CLEVELAND ST",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597155120",
"telephone_number": "503-319-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENOWICZ",
"first_name": "ROBERT",
"middle_name": "EMERY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2013-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VT",
"license": "0600003375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.