DR. PAULA SUE BENES M.D.
NPI 1346263647
Physical Medicine & Rehabilitation in Edwardsville, IL

Active since July 26, 2006PECOS EnrolledAccepts Medicare Assignment
71.56/100
CMS Quality Rating
3402 ANDERSON HEALTHCARE DR, EDWARDSVILLE, IL 62025(877) 749-7428(512) 628-3314 Get Directions Write a Review

NPPES record last updated: October 22, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Apr 3, 2024, Oct 13, 2020, Aug 22, 2019 (3 updates tracked since 2019).

About Dr. Paula Sue Benes M.d. NPPES

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

DR. PAULA SUE BENES M.D. (NPI 1346263647) is an individual physical medicine & rehabilitation provider in Edwardsville, Illinois, licensed in Illinois (036.168593) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of Medical College Of Wisconsin (1996).

NPPES Registry Identity

NPI1346263647
Entity TypeIndividualFemale
Primary Taxonomy208100000X
Provider Legal NameDR. PAULA SUE BENESCredential: M.D.
Location Address3402 ANDERSON HEALTHCARE DREdwardsville, IL 62025-7712
Mailing Address1776 Woodstead Ct Ste 208The Woodlands, TX 77380-1480 · (877) 749-7428 · Fax (877) 749-7428
Fax(512) 628-3314
Sole ProprietorNo
Medical School CMSMedical College Of WisconsinGraduated 1996
Enumeration DateJuly 26, 2006
Last NPPES UpdateOctober 22, 20253 updates tracked since enumeration
NPPES CertifiedOctober 22, 2025
NPI 1346263647 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPhysical Medicine & RehabilitationAllopathic & Osteopathic Physicians
Taxonomy Code208100000X
Licenses Licensed in IL · 036.168593 Licensed in MO · 2016016252
Definition
Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
Also ListedPhysical Medicine & Rehabilitation · Spinal Cord Injury MedicineTaxonomy 2081P0004X · License 036.168593 (IL)
3402 ANDERSON HEALTHCARE DR, Edwardsville, IL 62025

Other Identifiers 3

Medicaid1346263647WI
Medicaid200051119IL
Medicaid33344900WI

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Paula Sue Benes 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 ID345297677
PECOS Enrollment IDI20240312002219
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.

Areas of Expertise CMS Part B claims 4

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
401 services176 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
275 services137 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
178 services166 patients
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
33 services26 patients

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

71.56/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality58.22
Improvement Activities40
Cost44.23

Referred Medical Equipment & Supplies CMS DME claims 10

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

Walker, folding, wheeled, adjustable or fixed height E0143
DME-Other DME · category DE000N
2 suppliers15 claims15 services$48.52 avg. paid by Medicare
Walker, heavy duty, wheeled, rigid or folding, any type E0149
DME-Other DME · category DE000N
1 supplier11 claims11 services$7.83 avg. paid by Medicare
Commode chair, mobile or stationary, with detachable arms E0165
DME-Other DME · category DE000N
3 suppliers23 claims24 services$8.99 avg. paid by Medicare
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
2 suppliers37 claims38 services$38.08 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
2 suppliers21 claims21 services$16.07 avg. paid by Medicare
Manual wheelchair accessory, anti-tipping device, each E0971
DME-Wheelchairs · category DD021N
3 suppliers29 claims43 services$2.27 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.

Rehabilitation Hospital
3402 ANDERSON HEALTHCARE DR
EDWARDSVILLE, IL 62025
Physical Medicine & Rehabilitation
3402 ANDERSON HEALTHCARE DR
EDWARDSVILLE, IL 62025
Occupational Therapist
3402 ANDERSON HEALTHCARE DR
EDWARDSVILLE, IL 62025
Occupational Therapist
3402 ANDERSON HEALTHCARE DR
EDWARDSVILLE, IL 62025

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 Paula Benes's NPI number?

The NPI number for Paula Benes is 1346263647. It was assigned to this individual provider in the NPPES registry on July 26, 2006.

Where is Paula Benes located?

Paula Benes practices at 3402 Anderson Healthcare Dr, Edwardsville, IL 62025. The listed phone number is (877) 749-7428.

What is Paula Benes's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation with taxonomy code 208100000X.

Is Paula Benes enrolled in Medicare?

Yes. Paula Benes 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.

What insurance does Paula Benes accept?

Health plans from UnitedHealthcare list Paula Benes 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.

When was this NPI record last updated?

The NPPES record for Paula Benes was last updated on October 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.