DR. THOMAS JAMES BENDA JR. M.D.
NPI 1003897554
Otolaryngology in Dubuque, IA

Q: What is Thomas Benda's NPI number?

The NPI number for Thomas Benda is 1003897554. It was assigned to this individual provider in the NPPES registry on November 10, 2005.

Q: What is Thomas Benda's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Thomas Benda was last updated on July 31, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 10, 2005PECOS EnrolledAccepts Medicare Assignment

535 CEDAR CROSS ROAD, DUBUQUE, IA 52003(563) 588-0506(563) 588-0451 Get Directions Write a Review

NPPES record last updated: July 31, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Thomas James Benda Jr. M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. THOMAS JAMES BENDA JR. M.D. (NPI 1003897554) is an individual otolaryngology provider in Dubuque, Iowa, licensed in Iowa (29238) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS, is affiliated with Finley Hospital, and is a graduate of University Of Iowa, Rj & L Carver College Of Medicine (1987).

NPPES Registry Identity

NPI1003897554

Entity TypeIndividualMale

Primary Taxonomy207Y00000X

Provider Legal NameDR. THOMAS JAMES BENDA JR.Credential: M.D.

Location Address535 CEDAR CROSS ROADDubuque, IA 52003-7704

Mailing Address535 Cedar Cross RoadDubuque, IA 52003-7704 · (563) 588-0506 · Fax (563) 588-0451

Phone(563) 588-0506

Fax(563) 588-0451

Sole ProprietorNo

Medical School CMSUniversity Of Iowa, Rj & L Carver College Of MedicineGraduated 1987

Enumeration DateNovember 10, 2005

Last NPPES UpdateJuly 31, 2019

✔ NPI 1003897554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians

Taxonomy Code207Y00000X

License✔ Licensed in IA · 29238

Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

535 CEDAR CROSS ROAD, Dubuque, IA 52003

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Other Identifiers 3

Other040003712IA · Railroad Medicare Provide

Medicaid0100461IA

Other42098297112IA · John Deere Provider Id

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from NH Healthy Families, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Thomas James Benda Jr. M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4880634112

PECOS Enrollment IDI20100320000250, I20210218000092

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Thomas Benda reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Dubuque Ent Head & Neck Surgery P.C.

Same address

Otolaryngology

535 CEDAR CROSS ROAD
Dubuque, IA 52003

Reassigned Medicare billing, Iowa and Wisconsin enrollments
Medicare enrollment name: Dubuque Ent Head & Neck Surgery PC
3 clinicians in this Medicare group

NPI 1235110685 (563) 588-0506

Mercy Medical Center

57 mi

Psychiatry

5264 COUNCIL ST NE
Cedar Rapids, IA 52402

Reassigned Medicare billing, Iowa enrollment
387 clinicians in this Medicare group

NPI 1700834165 (319) 398-6575

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 12

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

182 services130 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

89 services80 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

83 services83 patients

Diagnostic exam of nasal passages using an endoscope 31231

A diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.

79 services43 patients

Diagnostic exam of voice box using a flexible endoscope 31575

This procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.

77 services66 patients

Exam of ear using a microscope 92504

An exam of the ear using a microscope allows a detailed view of the ear structures. This non-invasive procedure helps identify issues such as infections, blockages, or ear damage. It's a safe, quick, and painless way to evaluate ear health.

58 services32 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

35 services33 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

34 services34 patients

Removal of impacted ear wax 69210

Impacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.

33 services31 patients

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

33 services33 patients

Biopsy of related skin growth, first growth 11102

A biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.

23 services22 patients

Incision of eardrum with insertion of eardrum tube under local or topical anesthesia 69433

This procedure, known as a Myringotomy with Tube Insertion, involves making a small incision in the eardrum to drain fluid and relieve pressure. A tiny tube is then placed in the eardrum to prevent future fluid buildup. It's done under local or topical anesthesia.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Finley Hospital

Acute Care Hospitals · Dubuque, IA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number160117

Location350 North Grandview AvenueDubuque, IA 52001 · Dubuque County

Emergency services Birthing friendly

Guttenberg Municipal Hospital

Critical Access Hospitals · Guttenberg, IA

OwnershipGovernment - Local

CMS Certification Number161312

Location200 Main StreetGuttenberg, IA 52052 · Clayton County

Emergency services

Jackson County Regional Health Center

Critical Access Hospitals · Maquoketa, IA

OwnershipGovernment - Local

CMS Certification Number161329

Location700 W Grove StMaquoketa, IA 52060 · Jackson County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 52003 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$122.23 typical visit price

range $52.96 – $161.40

Typical copayment $30.55 (range $13.24 – $40.35)

Most-billed visit code 99204

Established Patient

$66.36 typical visit price

range $16.91 – $131.98

Typical copayment $16.59 (range $4.22 – $32.99)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

3 suppliers14 claims14 services$55.62 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

3 suppliers12 claims12 services$19.38 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DUBUQUE ENT HEAD & NECK SURGERY P.C.

Otolaryngology

535 CEDAR CROSS ROAD
DUBUQUE, IA 52003

Dubuque County (563) 588-0506

ROSEMARY BAUCHIERO AUD

Audiologist-Hearing Aid Fitter

535 CEDAR CROSS ROAD
DUBUQUE, IA 52003

Dubuque County (563) 588-0506

DANIEL JUSTIN GIVENS M.D.

Otolaryngology

535 CEDAR CROSS ROAD
DUBUQUE, IA 52003

Dubuque County (563) 588-0506

DR. GREGORY JOSEPH WHITE M.D.

Otolaryngology

535 CEDAR CROSS ROAD
DUBUQUE, IA 52003

Dubuque County (563) 588-0506

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thomas Benda's NPI number?

The NPI number for Thomas Benda is 1003897554. It was assigned to this individual provider in the NPPES registry on November 10, 2005.

Where is Thomas Benda located?

Thomas Benda practices at 535 Cedar Cross Road, Dubuque, IA 52003. The listed phone number is (563) 588-0506.

What is Thomas Benda's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is Thomas Benda enrolled in Medicare?

Yes. Thomas Benda is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Thomas Benda's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Thomas Benda reassigns Medicare benefits to 2 organizations: Dubuque Ent Head & Neck Surgery P.C. (Dubuque, IA) and Mercy Medical Center (Cedar Rapids, IA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Thomas Benda's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Thomas Benda accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from NH Healthy Families, Ambetter from Sunflower Health Plan and Anthem Blue Cross and Blue Shield and 3 other insurers list Thomas Benda as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Thomas Benda affiliated with any hospitals?

According to CMS data, Thomas Benda is affiliated with Finley Hospital, Guttenberg Municipal Hospital and Jackson County Regional Health Center.

When was this NPI record last updated?

The NPPES record for Thomas Benda was last updated on July 31, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.