Individual provider Active NPI

Jeffery Rusten Bennett, MD

  • Diagnostic Radiology Physician
  • Charleston, SC
National Provider Identifier
1770597528
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
29827 Issued in SC
Practice address
316 Calhoun St
Attn: Radiology Department
Charleston, SC 29401-1113
Phone
(843) 724-2000
NPI assigned
Jul 28, 2006
Last updated
Feb 13, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2004-00341 NC
Diagnostic Radiology Physician 2085R0202X 29827 SC Primary

Addresses

Primary practice location

316 Calhoun St
Attn: Radiology Department
Charleston, SC 29401-1113

Mailing address

PO Box 2363
Indianapolis, IN 46206-2363
Phone (843) 724-2154

Other identifiers 2

IdentifierTypeStateIssuer
P00403138OtherSCRR MCARE
298270MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000003 SC Practitioner - Diagnostic Radiology 7315948973 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
West Virginia University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Smi Imaging LLCGroup PAC ID 3476696220, 380 clinicians
Simonmed Imaging Florida LLCGroup PAC ID 6608036108, 302 clinicians

Practice addresses (Care Compare)

345 Hobcaw Dr
Mount Pleasant, SC 29464-2571
Phone (480) 306-6949

51 Cotillion CT
Georgetown, SC 29440-7052
Phone (480) 306-6949

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
75.71
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
75.71
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
29827SCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Simonmed Reno PLLC Diagnostic Radiology CurrentSince Jun 1, 2024 Accepting new patients
Simonmed Imaging Florida LLC Diagnostic Radiology CurrentSince Oct 6, 2023 Accepting new patients
Smi Imaging, LLC Diagnostic Radiology CurrentSince Jul 25, 2023 Accepting new patients
Roper Hospital Inc. PastSince Jul 1, 2007 Accepting new patients

Locations

16220 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392249600000",
    "number": "1770597528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2363",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462062363",
            "telephone_number": "843-724-2154",
            "fax_number": "317-663-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 CALHOUN ST",
            "address_2": "ATTN: RADIOLOGY DEPARTMENT",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294011113",
            "telephone_number": "843-724-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JEFFERY",
        "middle_name": "RUSTEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2004-00341",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "29827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCARE",
            "identifier": "P00403138",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298270",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.