Active NPI
Douglas M. Bennett, D.O.
- Emergency Medicine Physician
- Charleston, WV
National Provider Identifier
1730191131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 1791
- Practice address
- 501 Morris St
Charleston, WV 25301-1326 - Phone
- (304) 388-5432
- NPI assigned
- Aug 13, 2006
- Last updated
- Apr 16, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 1791 | WV | Primary |
| Internal Medicine Physician | 207R00000X | 1791 | WV |
Addresses
Primary practice location
501 Morris St
Charleston, WV 25301-1326
Mailing address
4750 Hempstead Station Dr
Kettering, OH 45429-5164
Phone (800) 875-0136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1800032-000 | Medicaid | WV |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1791 | WV | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluefield Emergency Physicians Inc | Emergency Medicine | Past | Accepting new patients |
Interoperability endpoints
- dbennett136462@direct.wvuhsdirect.com
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Bluefield, WV
- NPI 1073627089
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366070400000",
"number": "1730191131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4750 HEMPSTEAD STATION DR",
"city": "KETTERING",
"state": "OH",
"postal_code": "454295164",
"telephone_number": "800-875-0136",
"fax_number": "937-619-4150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 MORRIS ST",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011326",
"telephone_number": "304-388-5432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "DOUGLAS",
"middle_name": "M.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2013-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WV",
"license": "1791",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WV",
"license": "1791",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1800032-000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.