Active NPI
Bonna Benjamin, MD
- Pediatric Surgery Physician
- Amarillo, TX
National Provider Identifier
1861408015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- J8911
- Practice address
- 1901 Medi Park Dr
Ste 2051
Amarillo, TX 79106-2169 - Phone
- (806) 468-4300
- Fax
- (806) 468-4398
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J8911 | TX | |
| Pediatric Surgery Physician | 2086S0120X | J8911 | TX | Primary |
Addresses
Primary practice location
1901 Medi Park Dr
Ste 2051
Amarillo, TX 79106-2169
Mailing address
1400 Wallace Blvd
Attn: Credentialing Dept
Amarillo, TX 79106-1708
Phone (806) 468-4300
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100027640A | Medicaid | OK | |
| 124606807 | Medicaid | TX | |
| J8716 | Medicaid | NM | |
| 124606806 | Medicaid | TX |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J8911 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374019200000",
"number": "1861408015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 WALLACE BLVD",
"address_2": "ATTN: CREDENTIALING DEPT",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791061708",
"telephone_number": "806-468-4300",
"fax_number": "806-468-4398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 MEDI PARK DR",
"address_2": "STE 2051",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791062169",
"telephone_number": "806-468-4300",
"fax_number": "806-468-4398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENJAMIN",
"first_name": "BONNA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2013-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J8911",
"primary": false
},
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "TX",
"license": "J8911",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100027640A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124606807",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "J8716",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124606806",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.