Individual provider Active NPI

Tanner Robin Bennett, AUD

  • Audiologist
  • Moses Lake, WA
National Provider Identifier
1891361283
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
LD61301322 Issued in WA
Practice address
840 E Hill Ave
Moses Lake, WA 98837-2238
Phone
(509) 663-8711
NPI assigned
May 27, 2021
Last updated
May 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X LD61301322 WA Primary

Addresses

Primary practice location

840 E Hill Ave
Moses Lake, WA 98837-2238

Mailing address

820 N Chelan Ave
Wenatchee, WA 98801-2028
Phone (509) 663-8711

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0764.epichosted.com/FHIRProxy/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA, NE3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210615003374 ID Practitioner - Qualified Audiologist 0143620997
I20220519001282 WA Practitioner - Qualified Audiologist 0143620997 Reassigns benefits to 2 organizations
I20250429001923 NE Practitioner - Qualified Audiologist 0143620997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clearview Eye Clinic LTDGroup PAC ID 7416998232, 6 clinicians
Audio-Logic, PCGroup PAC ID 1456497064, 3 clinicians

Practice addresses (Care Compare)

2500 W a St
Suite 202
Moscow, ID 83843-6000
Phone (208) 882-4662

3763 39TH Ave
Suite 300
Columbus, NE 68601-4530
Phone (402) 564-9198

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
477NEMDMental Health Counselor
LD61301322WAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Audio-Logic, PC Audiologist CurrentSince Jun 11, 2025 Accepting new patients
Wenatchee Valley Hospital CurrentSince May 10, 2022 Accepting new patients
Wenatchee Valley Hospital Current Accepting new patients
Central Washington Health Services Association Current Accepting new patients
Ozark Tri-County Health Care Consortium Past Accepting new patients

Locations

3763 39th Ave
Ste 300
Columbus, NE 68601
Phone (402) 564-9198

840 E Hill Ave
Moses Lake, WA 98837
Phone (509) 764-6400

17 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2174

1201 S Miller St
Wenatchee, WA 98801
Phone (509) 662-2208

820 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 863-4868

933 Red Apple Rd
Wenatchee, WA 98801
Phone (509) 655-6125

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1891361283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E HILL AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372238",
            "telephone_number": "509-663-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "TANNER",
        "middle_name": "ROBIN",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-27",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WA",
            "license": "LD61301322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0764.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "840 E Hill Ave",
            "city": "Moses Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988372238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.