Derek T Bennetsen, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

M2257 Issued in TX

Practice address

12221 Merit Dr
Suite 1610
Dallas, TX 75251-2202

Phone

(214) 217-1911

NPI assigned

Jul 8, 2006

Sex

Male

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 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: dbennetsen443607@direct.texashealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abk Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Alice, TX
  • NPI 1801983036
  NPD (past)
• Emergis ER Coit, LLC

  • Special Hospital
  • Dallas, TX
  • NPI 1891239935
  NPD (past)
• Patriot Emergency Physicians PLLC

  • Emergency Medicine Physician
  • El Paso, TX
  • NPI 1285689174
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227139200000",
    "number": "1720011232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202",
            "telephone_number": "214-217-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETSEN",
        "first_name": "DEREK",
        "middle_name": "T",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2008-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "M2257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8AL417",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00388057",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181816301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90058763",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181816302",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181816304",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8W1788",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8W0731",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Benjamin, M.S., CCC-SLP
• Richard Lee Benjamin
• Tyler Davis Benjamin
• Shelbie Marie Benker, BCBA, LBA
• Michal Benkler Sullivan, MD
• Carol Jane Bennett Clay
• Janet Bennett Jacobs, LCSW-ACP
• Hillary Bennett-Baker, CCC-SLP
• Anne Lucille Bennett, MD
• Asia Brianna Bennett, LCSW

• Emergency Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; 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.