NPIMap

Organization Active NPI

Jeffrey a Berenson MD a Professional Corporation

  • Internal Medicine Physician
  • Mendocino, CA
National Provider Identifier
1881625671
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
JEFFREY A BERENSON MD A PROFESSIONAL CORPORATION
Practice address
45081 Little Lake Street
Mendocino, CA 95460
Phone
(707) 937-1055
Fax
(707) 937-1061
NPI assigned
Jul 6, 2006
Last updated
Apr 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Authorized official

Name
Dr. Jeffrey A Berenson, MDNPI 1902828619
Title
Ceo Owner
Phone
(707) 937-1055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

45081 Little Lake Street
Mendocino, CA 95460

Mailing address

PO Box 38
Mendocino, CA 95460
Phone (707) 937-1055

Other identifiers 3

IdentifierTypeStateIssuer
00G395740OtherCAMEDI-CAL
00G395740OtherCABLUE CROSS
00G395740OtherCABLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1881625671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "95460",
            "telephone_number": "707-937-1055",
            "fax_number": "707-937-1061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45081 LITTLE LAKE STREET",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "95460",
            "telephone_number": "707-937-1055",
            "fax_number": "707-937-1061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY A BERENSON MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "BERENSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "707-937-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "00G395740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00G395740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G395740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendocino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.

Verify at the official NPI Registry.