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  7. NPI Record 1215930607

DR. ADREA R BENKOFF M.D.
Complete NPI Record 1215930607
Ophthalmology in Warren, MI

NPI Status: Active since May 31, 2005

Contact Information

29753 HOOVER RD
STE A
WARREN, MI
ZIP 48093
Phone: (586) 573-4333
Fax: (586) 573-2149

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Second Line Business Mailing Address
  10. Provider Business Mailing Address City Name
  11. Provider Business Mailing Address State Name
  12. Provider Business Mailing Address Postal Code
  13. Provider Business Mailing Address Country Code If outside U S
  14. Provider Business Mailing Address Telephone Number
  15. Provider Business Mailing Address Fax Number
  16. Provider First Line Business Practice Location Address
  17. Provider Second Line Business Practice Location Address
  18. Provider Business Practice Location Address City Name
  19. Provider Business Practice Location Address State Name
  20. Provider Business Practice Location Address Postal Code
  21. Provider Business Practice Location Address Country Code If outside U S
  22. Provider Business Practice Location Address Telephone Number
  23. Provider Business Practice Location Address Fax Number
  24. Provider Enumeration Date
  25. Last Update Date
  26. Provider Gender Code
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Other Provider Identifier 1
  32. Other Provider Identifier Type Code 1
  33. Other Provider Identifier State 1
  34. Other Provider Identifier Issuer 1
  35. Other Provider Identifier 2
  36. Other Provider Identifier Type Code 2
  37. Other Provider Identifier State 2
  38. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1215930607. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1215930607
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: ADREA
The first name of the provider, if the provider is an individual.
Provider Middle Name: R
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: M.D.
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider First Line Business Mailing Address: 29753 HOOVER RD
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Second Line Business Mailing Address: STE A
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Business Mailing Address City Name: WARREN
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address State Name: MI
Other name by which the organization provider is or has been known.
Provider Business Mailing Address Postal Code: 480938900
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider Business Mailing Address Country Code If outside U S : US
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address Telephone Number: 5865734333
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Fax Number: 5865732149
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider First Line Business Practice Location Address: 29753 HOOVER RD
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Second Line Business Practice Location Address: STE A
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WARREN
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MI
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 480938900
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5865734333
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5865732149
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/31/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 6/24/2010
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207W00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 4301039828
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: MI
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 1805004581
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
The 10-position telephone number of the authorized official.
Other Provider Identifier State 1: MI
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Other Provider Identifier Issuer 1: BLUE SHIELD OF MICHIGAN
Other Provider Identifier 2: 1683682
Other Provider Identifier Type Code 2: 05
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Other Provider Identifier State 2: MI
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Is Sole Proprietor: N