Individual provider Active NPI

Jeffrey C Benson, MD

  • Pediatric Pulmonology Physician
  • Indianapolis, IN
National Provider Identifier
1851342208
Registry record updated Dec 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
01079551 Issued in IN
Practice address
705 Riley Hospital Dr
Roc 4270
Indianapolis, IN 46202-5109
Phone
(317) 944-7208
Fax
(317) 944-3442
NPI assigned
May 12, 2006
Last updated
Dec 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2017

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 336062517 IL
Pediatric Critical Care Medicine Physician 2080P0203X 42087 WI
Pediatric Pulmonology Physician 2080P0214X 336062517 IL
Pediatric Pulmonology Physician 2080P0214X 01079551 IN Primary

Addresses

Primary practice location

705 Riley Hospital Dr
Roc 4270
Indianapolis, IN 46202-5109

Mailing address

PO Box 1026
Indianapolis, IN 46206-1026
Phone (317) 777-6435

Other practice location 1

420 NE Glen Oak Ave Ste 401
University of Illinois College of Medicine - Pulm
Peoria, IL 61603-3168
Phone (309) 624-4535

Other identifiers 3

IdentifierTypeStateIssuer
008000215POtherHUMANA
036099719MedicaidIL
32640800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20111024000320 IL Practitioner - Pulmonary DiseasePractitioner - Pediatric Medicine 1355424060 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42087WIMDPediatric Critical Care Medicine Physician
336062517ILMDPediatric Pulmonology Physician
01079551INMDPediatric Pulmonology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Aug 29, 2011 Accepting new patients
Osf Multi-Specialty Group CurrentSince Feb 12, 2024 Accepting new patients
Board of Trustees of the University of Illinois CurrentSince Aug 29, 2011 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

7694 Solutions Ctr
Chicago, IL 60677

420 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 655-2343

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1 Illini Dr
Peoria, IL 61605
Phone (309) 671-3000

420 NE Glen Oak Ave
Ste 401
Peoria, IL 61603
Phone (309) 624-9259

Organizations & group practices 5

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512950400000",
    "number": "1851342208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1026",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061026",
            "telephone_number": "317-777-6435",
            "fax_number": "317-777-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 RILEY HOSPITAL DR",
            "address_2": "ROC 4270",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025109",
            "telephone_number": "317-944-7208",
            "fax_number": "317-944-3442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 NE Glen Oak Ave Ste 401",
            "address_2": "University of Illinois College of Medicine - Pulm",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616033168",
            "country_code": "US",
            "telephone_number": "309-624-4535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENSON",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2017-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "IL",
            "license": "336062517",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "WI",
            "license": "42087",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "IL",
            "license": "336062517",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "IN",
            "license": "01079551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "008000215P",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099719",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32640800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.