NPIMap

Individual provider Active NPI

Benjamin Bansun Chang, MD

  • Vascular Surgery Physician
  • Williamsport, PA
National Provider Identifier
1023008117
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD476246 Issued in PA
Practice address
740 High St Ste 2001
Williamsport, PA 17701-3102
Phone
(703) 212-8055
NPI assigned
Oct 28, 2005
Last updated
Jan 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 1697666 NY
Vascular Surgery Physician 2086S0129X 169766 NY
Vascular Surgery Physician 2086S0129X MD476246 PA Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 169766 NY

Addresses

Primary practice location

740 High St Ste 2001
Williamsport, PA 17701-3102

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900
Phone (570) 326-8723

Other identifiers 1

IdentifierTypeStateIssuer
01022251MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220112002155 PA Practitioner - Vascular Surgery 4183618416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Albany Medical College of Union University, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians

Practice addresses (Care Compare)

740 High St
Suite 3001
Williamsport, PA 17701-3111
Phone (570) 321-2805

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1697666NYMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Feb 1, 2022 Accepting new patients
Susquehanna Physician Services Vascular Surgery CurrentSince Feb 1, 2022 Accepting new patients

Locations

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-2000

740 High St
Ste 2001
Williamsport, PA 17701
Phone (570) 321-2805

740 High St
Ste 3001
Williamsport, PA 17701
Phone (570) 321-2805

Interoperability endpoints

  • Direct secure messaging: bchang57200@upmc.direct-ci.com
  • Direct secure messaging: benjamin.b.chang@upmcdirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1023008117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900",
            "telephone_number": "570-326-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HIGH ST STE 2001",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013102",
            "telephone_number": "703-212-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "BENJAMIN",
        "middle_name": "BANSUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "1697666",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "169766",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD476246",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NY",
            "license": "169766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01022251",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.