Gordon A Benner, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A21842 Issued in CA

Practice address

3000 Colby St.
Ste 304
Berkeley, CA 94705

Phone

(510) 848-7533

Fax

(510) 848-0105

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12068/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Berkeley Primary Care Medical Corporation

  • Family Medicine Physician
  • Berkeley, CA
  • NPI 1932147568
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377129600000",
    "number": "1861436529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 COLBY ST.",
            "address_2": "STE 304",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94705",
            "telephone_number": "510-848-7533",
            "fax_number": "510-848-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 COLBY ST.",
            "address_2": "STE 304",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94705",
            "telephone_number": "510-848-7533",
            "fax_number": "510-848-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNER",
        "first_name": "GORDON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2013-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A21842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Beloff
• Sherrie Evelyn Beltran
• Stephanie Beltran
• Donald Ira Bender, MFCT
• Lara Natasha Benefield, LMFT
• Alexander Jason Bennett, PH.D.
• Kathy Bennett
• Raquel Bennett
• Sarah Elise Bennett, OTR/L
• Jennifer L Benorden, CMT

• Family Medicine Physician in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.