NPIMap

Individual provider Active NPI

Benjamin J Kolner, PA-C

  • Physician Assistant
  • Davenport, IA
National Provider Identifier
1871934851
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002418 Issued in IA
Practice address
3385 Dexter CT Ste 103
Davenport, IA 52807-3471
Phone
(563) 441-5860
Fax
(563) 441-5865
NPI assigned
Jul 8, 2013
Last updated
Feb 5, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.004768 IL
Physician Assistant 363A00000X 002418 IA Primary

Addresses

Primary practice location

3385 Dexter CT Ste 103
Davenport, IA 52807-3471

Mailing address

3385 Dexter CT Ste 103
Davenport, IA 52807-3471
Phone (563) 441-5860

Other identifiers 1

IdentifierTypeStateIssuer
1871934851MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131008000937 IA Practitioner - Physician Assistant 7416181383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4311 E 53Rd St
Davenport, IA 52807-3860
Phone (563) 441-5860

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.004768ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Aug 26, 2013 Accepting new patients
Iowa Physicians Clinic Medical Foundation Physician Assistant CurrentSince Aug 26, 2013 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

3385 Dexter Ct
Ste 103
Davenport, IA 52807
Phone (563) 441-5860

4311 E 53rd St
Davenport, IA 52807
Phone (563) 441-5860

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

Interoperability endpoints

  • Direct secure messaging: bkolner152456@direct.unitypoint.org

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1871934851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT STE 103",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-441-5860",
            "fax_number": "563-441-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT STE 103",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-441-5860",
            "fax_number": "563-441-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLNER",
        "first_name": "BENJAMIN",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-08",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004768",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871934851",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.