MR. ROOSEVELT BENNETT JR. AA-C
NPI 1184900177
Anesthesiologist Assistant in Jacksonville, FL

Q: What is Roosevelt Bennett's NPI number?

The NPI number for Roosevelt Bennett is 1184900177. It was assigned to this individual provider in the NPPES registry on October 23, 2011.

Q: What is Roosevelt Bennett's specialty?

The primary specialty registered for this NPI is Anesthesiologist Assistant with taxonomy code 367H00000X.

Q: When was this NPI record last updated?

The NPPES record for Roosevelt Bennett was last updated on January 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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 October 23, 2011

807 CHILDRENS WAY, NEMOURS CHILDRENS SPECIALTY CARE, JACKSONVILLE, JACKSONVILLE, FL 32207(904) 697-3600(904) 697-3927 Get Directions Write a Review

NPPES record last updated: January 9, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Mr. Roosevelt Bennett Jr. Aa-c NPPES

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

MR. ROOSEVELT BENNETT JR. AA-C (NPI 1184900177) is an individual anesthesiologist assistant in Jacksonville, Florida, licensed in Florida (AA100) and active in the NPI registry since October 2011.

NPPES Registry Identity

NPI1184900177

Entity TypeIndividualMale

Primary Taxonomy367H00000X

Provider Legal NameMR. ROOSEVELT BENNETT JR.Credential: AA-C

Location Address807 CHILDRENS WAY, NEMOURS CHILDRENS SPECIALTY CARE, JACKSONVILLEJacksonville, FL 32207-8426

Mailing AddressPo Box 191, Provider Enrollment DepartmentRockland, DE 19732-0191 · (904) 697-4201 · Fax (302) 651-4945

Phone(904) 697-3600

Fax(904) 697-3927

Sole ProprietorNo

Enumeration DateOctober 23, 2011

Last NPPES UpdateJanuary 9, 2017

✔ NPI 1184900177 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologist AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367H00000X

License✔ Licensed in FL · AA100

Definition

An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist.

807 CHILDRENS WAY, Jacksonville, FL 32207

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Other Identifiers 1

Medicaid004228800FL

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Roosevelt Bennett Jr. Aa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

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

The Nemours Foundation

Same address

Multi-Specialty

807 CHILDRENS WAY
Jacksonville, FL 32207

Reassigned Medicare billing, Florida enrollment
703 clinicians in this Medicare group

NPI 1265585806 (904) 697-3600

Us Anesthesia Partners Of Florida Inc.

117 mi

Anesthesiology

851 TRAFALGAR CT, SUITE 200E
Maitland, FL 32751

Reassigned Medicare billing, Florida enrollment
2,356 clinicians in this Medicare group

NPI 1518910520 (321) 422-7155

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

Other Providers at the Same Location NPPES 20

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

DR. KENNETH FRANZ-JOSEPH HEARN MD

Pediatrics

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (904) 697-3600

MR. HUGH E. GRIFFENKRANZ PA-C

Physician Assistant

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (904) 390-3737

JACQUELINE M NOE

Physician Assistant

807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE
JACKSONVILLE, FL 32207

Duval County (904) 697-3600

ERIC P. SHERLIN R.PH

Pharmacist

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (904) 390-3601

KELLY MARIE SUMMERS ARNP

Nurse Practitioner

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (904) 697-3600

ROBERT C SPRECHER MD

Otolaryngology (Pediatric Otolaryngology)

807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE
JACKSONVILLE, FL 32207

Duval County (904) 697-3694

DR. DOREEN RADJENOVIC ARNP

Nurse Practitioner

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (904) 390-3759

GRACE ELIZABETH ALLEMAN SLP

Speech-Language Pathologist

807 CHILDRENS WAY
JACKSONVILLE, FL 32207

Duval County (907) 697-3600

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 Roosevelt Bennett's NPI number?

The NPI number for Roosevelt Bennett is 1184900177. It was assigned to this individual provider in the NPPES registry on October 23, 2011.

Where is Roosevelt Bennett located?

Roosevelt Bennett practices at 807 Childrens Way Nemours Childrens Specialty Care, Jacksonville, Jacksonville, FL 32207. The listed phone number is (904) 697-3600.

What is Roosevelt Bennett's specialty?

The primary specialty registered for this NPI is Anesthesiologist Assistant with taxonomy code 367H00000X.

Is Roosevelt Bennett enrolled in Medicare?

Yes. Roosevelt Bennett is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Roosevelt Bennett's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Roosevelt Bennett reassigns Medicare benefits to 2 organizations: The Nemours Foundation (Jacksonville, FL) and Us Anesthesia Partners Of Florida Inc. (Maitland, FL). 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 Roosevelt Bennett's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Roosevelt Bennett was last updated on January 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.