Jessica Bennett, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

53218 Issued in ID

Practice address

3679 S Shortleaf Ave
Boise, ID 83716-8617

Phone

(208) 391-3995

NPI assigned

Jan 6, 2015

Last updated

Aug 26, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2021 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

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.

• Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1336656040
  NPD (past)

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1699163170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3679 S SHORTLEAF AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837168617",
            "telephone_number": "208-391-3995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3679 S SHORTLEAF AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837168617",
            "telephone_number": "208-391-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JESSICA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-06",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "ID",
            "license": "53218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699163170",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Breeanna Bengtzen, ATC, LAT, MAL
• Charlotte Benjamin
• Spencer Benjamin, DPT
• Ceanna Benner, PT, DPT
• Ashley W Bennett, MD
• Kristen Ray Bennett, LCSW
• Matthew Scott Bennett, PHD
• Renee Rachelle Bennett, RN
• Robert Todd Bennett, PH.D.
• Sharon Bennett, MSN, SPRN, FNP-C

• Advanced Practice Midwife in Boise, ID
• Providers in Boise, ID by specialty
• Advanced Practice Midwife in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.