Kim E Bennett, P.A.
Individual provider Active NPI Family Medicine Physician · Banning, CA
NPI 1992733141 · NPPES record last updated Dec 3, 2021
Key facts
- NPI
- 1992733141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- PA17027 (CA)
- Practice address
- 6109 W Ramsey St
Banning, CA 92220-3051 - Phone
- (951) 845-0313
- Fax
- (909) 796-4158
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040128001068 | CA | Practitioner - Physician Assistant | 5395648273 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PA17027 | CA | Yes |
Addresses
Primary practice location
6109 W Ramsey St
Banning, CA 92220-3051
Mailing address
PO Box 2200
Redlands, CA 92373-0722
Phone (909) 793-3311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPA170270 | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Banning, CA
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- Lea Nicole Bell
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- Shelly Marie Belmonte
- Blanca Estela Benitez
- Sarah D Bergeson
- Amsale Berhanu-Demissie
- Jale Berhanu
- Taylor D Berry
- Erica Lynn Tarango Bhambi
All providers in Banning, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2021. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.