Joseph S Bennett, PA
Individual provider Active NPI Physician Assistant · Muskogee, OK
NPI 1831156983 · NPPES record last updated Feb 17, 2010
Key facts
- NPI
- 1831156983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 718 (OK)
- Practice address
- 615 S 32ND St
Muskogee, OK 74401-5012 - Phone
- (918) 687-3994
- Fax
- (918) 687-1809
- NPI assigned
- May 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050715000032 | OK | Practitioner - Physician Assistant | 1355382631 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 718 | OK | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stigler Health and Wellness Center Inc | Current |
Accepting new patients | |
| Cardiology Clinic of Muskogee, Inc. | Past | Accepting new patients |
Locations
1505 E Main St
Stigler, OK 74462
Phone (800) 640-9741
Interoperability endpoints
- https://api.platform.athenahealth.com/3442/brand/1/csg/61/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 718 | OK | Yes |
Addresses
Primary practice location
615 S 32ND St
Muskogee, OK 74401-5012
Mailing address
615 S 32ND St
Muskogee, OK 74401-5012
Phone (918) 687-3994
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100212410C | Medicaid | OK |
Other providers in Muskogee, OK
- Kari Lu Beem
- Amanda Brooke Bell
- Zakiya Asha Bell
- Wendy Bellora
- Shawn Dale Bemo
- Kelli Bennett
- Kate Bennish
- Kelley Benson
- Stephanie Beratto
- Lacey Layne Bernheisel
All providers in Muskogee, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.