Active NPI
Mark R Bennett, M.D.
- Anesthesiology Physician
- Morgantown, WV
National Provider Identifier
1851369755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 13482
- Practice address
- 101 Stadium Dr
Morgantown, WV 26506-7911 - Phone
- (304) 598-4000
- NPI assigned
- Mar 8, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 13482 | WV | Primary |
Addresses
Primary practice location
101 Stadium Dr
Morgantown, WV 26506-7911
Mailing address
PO Box 897
Morgantown, WV 26507-0897
Phone (304) 293-7401
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 409551100 | Medicaid | MD | |
| 0011245770006 | Medicaid | PA | |
| 0698428 | Medicaid | OH | |
| 0057577000 | Medicaid | WV | |
| 64113103 | Medicaid | KY |
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 Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1851369755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 897",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265070897",
"telephone_number": "304-293-7401",
"fax_number": "304-293-6963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 STADIUM DR",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265067911",
"telephone_number": "304-598-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "MARK",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-08",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WV",
"license": "13482",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "409551100",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011245770006",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0698428",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0057577000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64113103",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.