Jorge A Benavente, OPTOMETRIST PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

18001807B Issued in IN

Practice address

9175 Calumet Ave
Munster, IN 46321-2805

Phone

(219) 836-7800

Fax

(219) 836-4806

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Indiana University - School of Optometry, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dr. Jorge a. Benavente Optometrist PC

  • Optometrist
  • Munster, IN
  • NPI 1063740744

  IL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1952409583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9175 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212805",
            "telephone_number": "219-836-7800",
            "fax_number": "219-836-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9175 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212805",
            "telephone_number": "219-836-7800",
            "fax_number": "219-836-4806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENAVENTE",
        "first_name": "JORGE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OPTOMETRIST PC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-0006940",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001807B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100157520A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "351517961",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Scott Beauregard, MD
• Karen R. Beavin, OTR, CHT
• Gerald Beck, FNP-BC
• Gwen Behm, PA-C
• Laila Belton
• Kevin F Benfield, MD
• Takita Benford
• Raoaa Benkhadra, M.D
• Diane Louise Benner, MSN, RN, IBCLC, RLC
• Kyra Bennett

• Optometrist in Munster, IN
• Providers in Munster, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.