Active NPI
Maverene Bennett
- Community Health Worker
- Las Vegas, NV
National Provider Identifier
1700519048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102 - Phone
- (702) 893-2001
- NPI assigned
- Jul 5, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102
Mailing address
3210 W Charleston Blvd Ste 2
Las Vegas, NV 89102
Phone (702) 893-2001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111111111111111 | Medicaid | NV |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | clear |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1700519048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 W CHARLESTON BLVD STE 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89102",
"telephone_number": "702-893-2001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3210 W CHARLESTON BLVD STE 2",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89102",
"telephone_number": "702-893-2001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "MAVERENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-05",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "111111111111111",
"state": "NV"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "clear",
"affiliation": "N",
"address_1": "3210 W Charleston Blvd Ste 2",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "89102",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.