Randall L Bennett, M.D.
Individual provider Active NPI Emergency Medicine Physician · Tucson, AZ
NPI 1962402800 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1962402800
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 23428 (AZ)
- Practice address
- 350 N Wilmot Rd
Tucson, AZ 85711-2602 - Phone
- (520) 872-7130
- NPI assigned
- Jul 21, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100407000367 | AZ | Practitioner - Emergency Medicine | 7517944283 | Reassigns benefits to 3 organizations |
| I20190822002377 | TX | Practitioner - Emergency Medicine | 7517944283 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23428 | AZ | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Carlos Apache Healthcare Corporation | Current |
Accepting new patients | |
| Bisbee Hospital Association | Current |
Accepting new patients | |
| Benson Hospital Corporation | Current |
Accepting new patients | |
| San Carlos Apache Healthcare Corporation | Current | Accepting new patients | |
| Bisbee Hospital Association | Current | Accepting new patients | |
| Nes Arizona Inc | Emergency Medicine | Current | Accepting new patients |
| Nes Arizona Inc | Emergency Medicine | Current |
Accepting new patients |
| Copper Queen Medical Associates Douglas | Current |
Accepting new patients | |
| Benson Hospital Corporation | Current |
Accepting new patients | |
| Emergency Room Associates | Past | Accepting new patients | |
| Emergency Room Associates Limited | Emergency Medicine | Past | Accepting new patients |
Locations
450 S Ocotillo St
Benson, AZ 85602
Phone (520) 586-2261
101 Cole Ave
Bisbee, AZ 85603
Phone (520) 432-5383
5330 S Highway 95
Fort Mohave, AZ 86426
Phone (928) 788-2273
103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200
7300 State Highway 121
Ste 374
McKinney, TX 75070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 23428 | AZ | Yes |
Addresses
Primary practice location
350 N Wilmot Rd
Tucson, AZ 85711-2602
Mailing address
2202 N Forbes Blvd
Tucson, AZ 85745-1412
Phone (520) 872-7130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 359340 | Medicaid | AZ |
Other providers in Tucson, AZ
- Jeffrey Alan Bennett
- John William Bennett
- Kiana Lauren Xuhui Bennett
- Lauren S Bennett
- Michele Helen Bennett
- Shyla Bennett
- Steven Bennett
- William Bennett
- Amber Lee Bennington
- Catherine Benoit
All providers in Tucson, AZ · Emergency Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.