Active NPI
Paul John Bennett
- Physical Medicine & Rehabilitation Physician
- Peoria, IL
National Provider Identifier
1780933770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 070019448
- Practice address
- 100 NE Randolph Ave
Peoria, IL 61606-1919 - Phone
- (309) 683-8170
- NPI assigned
- Sep 5, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 070019448 | IL | Primary |
Addresses
Primary practice location
100 NE Randolph Ave
Peoria, IL 61606-1919
Mailing address
100 NE Randolph Ave
Peoria, IL 61606-1919
Phone (309) 683-8170
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070019448 | IL | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346803200000",
"number": "1780933770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 NE RANDOLPH AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616061919",
"telephone_number": "309-683-8170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 NE RANDOLPH AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616061919",
"telephone_number": "309-683-8170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "PAUL",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2012-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IL",
"license": "070019448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
- Sharon Ann Benivegna, MA, CCC-A
- Stephen Michael Benjamin, D.M.D., M.S.
- Jennifer A Benne, BEHAVIOR ANALYST
- Emily Christine Bennett
- Jackson Romaine Bennett Jr., O.D.
- Benningfield & Associates, LLC
- Jason Ryan Benningfield, D.C.
- Robert Craig Benningfield, DC
- Andrew S Bennington
- Brooke Benson, PT, DPT, CSRS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.