Physician Compare National (NPI:1205809076)

HEALTHCARE PROVIDER: DANIEL C BENNETT MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1205809076
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2567451354
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040507000585
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BENNETT
	Individual professional last name
Provider First Name	DANIEL
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL RADIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL RADIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	501 S RAGSDALE
	Group Practice or individual's line 1 address
Line 2 Street Address	ETMC RADIOLOGY DEPT
	Group Practice or individual's line 2 address
City	JACKSONVILLE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	757662434
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450194
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EAST TEXAS MEDICAL CENTER JACKSONVILLE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450236
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450475
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ETMC HENDERSON
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	450083
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	EAST TEXAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	450210
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	EAST TEXAS MEDICAL CENTER - CARTHAGE
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1205809076)

HEALTHCARE PROVIDER: DANIEL C BENNETT MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information