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Active NPI 1063404036 Individual Practitioner Male Practitioner

Fred A Benjamin Iv , CRNA

Registered Nurse • Jackson, TN

Professional Overview & Biography Verified Profile Summary

Fred Benjamin Iv, CRNA is a registered healthcare professional specializing in Registered Nurse in Jackson, TN. Practice services are available at 36 BRENTSHIRE SQ under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

36 Brentshire Sq

Jackson, TN 383052245

Telephone 7316641717
Fax 7316647114
Associated Practice Facility / Clinic
🏢 Sec Consulting Firm, Pllc Facility NPI 1508170127

Specialty Benchmarks & Practice Insights

Comparative analytics for Registered Nurse in Jackson, TN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 4.0 Yrs
Regional Practice Density
34 Specialists

Practicing in Jackson, TN (3394 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Registered Nurse Primary Specialty

NUCC Taxonomy Code: 163W00000X

State License TN RN0000085124

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
3622768 (TN)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Matthew Long , CRNA

Nurse Anesthetist, Certified Registered

NPI 1093707945

Certified Registered Nurse Anesthetist

Connie Lynn , CRNA

Nurse Anesthetist, Certified Registered

NPI 1366464620

Certified Registered Nurse Anesthetist

John Turner , CRNA

Registered Nurse

NPI 1407848344

Certified Registered Nurse Anesthetist

Brent Earwood , CRNA

Nurse Anesthetist, Certified Registered

NPI 1487651402

Certified Registered Nurse Anesthetist

Delana Potter , CRNA

Nurse Anesthetist, Certified Registered

NPI 1558378133

Certified Registered Nurse Anesthetist

Mark Foster , CRNA

Nurse Anesthetist, Certified Registered

NPI 1861641714

Certified Registered Nurse Anesthetist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 36 BRENTSHIRE SQ, JACKSON, TN 383052245 (Tel: 7316641717)

📍
Updated Business Mailing Address July 08, 2007

Registered at 70 STATE ROUTE 420, HUMBOLDT, TN 383435619 (Tel: 7318241939)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as FRED BENJAMIN IV, CRNA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Registered Nurse (License #RN0000085124 in TN)

🟢
Initial NPI Registration & Enumeration August 16, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063404036
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 16, 2005
Last Update: July 13, 2026
Sole Proprietor: No

Mailing Address

70 State Route 420

Humboldt, TN 383435619

Phone: 7318241939

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.