NPIMap

Organization Active NPI

Independence Medical, PA

  • Geriatric Medicine (Family Medicine) Physician
  • Smithfield, NC
National Provider Identifier
1700845112
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
36493 Issued in NC
Legal business name
INDEPENDENCE MEDICAL, PA
Practice address
515 Barbour Rd
Smithfield, NC 27577-7698
Phone
(919) 544-4747
Fax
(919) 544-0104
NPI assigned
Mar 23, 2006
Last updated
Oct 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

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

Authorized official

Name
Bernard L Bennett, M.D.
Title
President
Phone
(919) 622-8272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 36493 NC Primary

Addresses

Primary practice location

515 Barbour Rd
Smithfield, NC 27577-7698

Mailing address

1209 Falls Bridge Dr
Raleigh, NC 27614-8935
Phone (919) 544-4747

Other identifiers 4

IdentifierTypeStateIssuer
1028PMedicaidNC
P00062870OtherNCMEDICARE RAILROAD
891028PMedicaidNC
DA5493OtherNCMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

321 E Carver St
Durham, NC 27704
Phone (919) 471-3558

3909 Sunset Ridge Rd
Ste 130
Raleigh, NC 27607
Phone (919) 544-4747

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1700845112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 FALLS BRIDGE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148935",
            "telephone_number": "919-544-4747",
            "fax_number": "919-544-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BARBOUR RD",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275777698",
            "telephone_number": "919-544-4747",
            "fax_number": "919-544-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2013-10-31",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-622-8272",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "36493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028P",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00062870",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891028P",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA5493",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithfield, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.