Individual provider Active NPI

Max Benson, M.D.

  • Interventional Cardiology Physician
  • Cumming, GA
National Provider Identifier
1093009425
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
83922 Issued in GA
Practice address
1505 Northside Forsyth Dr
Ste 3600
Cumming, GA 30041
Phone
(770) 343-8565
Fax
(770) 781-3559
NPI assigned
Jun 2, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA09516000 NJ
Internal Medicine Physician 207R00000X 276976 NY
Interventional Cardiology Physician 207RI0011X 83922 GA Primary

Addresses

Primary practice location

1505 Northside Forsyth Dr
Ste 3600
Cumming, GA 30041

Mailing address

506 6TH St
East Pavillion 3
Brooklyn, NY 11215-3609
Phone (718) 780-5246

Other names 1

  • Dr. Peyman Farzanfar Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address NorthsideHeart@Northside.gwaydirect.com Direct
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141224000779 NY Practitioner - Internal Medicine 8123340650 Reassigns benefits to 1 organization
I20191118002245 GA Practitioner - Interventional Cardiology 8123340650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

1505 Northside Forsyth Dr
Suite 3600
Cumming, GA 30041
Phone (770) 343-8565

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting22

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09516000NJMDInternal Medicine Physician
83922GAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Aug 1, 2017 Accepting new patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Aug 1, 2017 Accepting new patients
Northside Cardiovascular Professional Services, LLC CurrentSince Oct 14, 2019 Accepting new patients

Locations

2000 Howard Farm Dr
Ste 200
Cumming, GA 30041
Phone (770) 667-4337

2000 Howard Farm Dr
Ste 450
Cumming, GA 30041
Phone (901) 489-4991

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

Organizations & group practices 3

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

Hospital & facility affiliations 5

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": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1093009425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 6TH ST",
            "address_2": "EAST PAVILLION 3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609",
            "telephone_number": "718-780-5246",
            "fax_number": "718-780-3259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE FORSYTH DR",
            "address_2": "STE 3600",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30041",
            "telephone_number": "770-343-8565",
            "fax_number": "770-781-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENSON",
        "first_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-02",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA09516000",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "276976",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "GA",
            "license": "83922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NorthsideHeart@Northside.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "1505 Northside Forsyth Dr",
            "address_2": "Ste 3600",
            "city": "Cumming",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP- Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PEYMAN",
            "last_name": "FARZANFAR",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.