Individual provider Active NPI

Benjamin Klar

  • Surgical Physician Assistant
  • Moultrie, GA
National Provider Identifier
1104699628
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
12001 Issued in GA
Practice address
16 Live Oak CT
Moultrie, GA 31768-6783
Phone
(229) 785-2400
NPI assigned
Nov 6, 2023
Last updated
Sep 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 12001 GA Primary

Addresses

Primary practice location

16 Live Oak CT
Moultrie, GA 31768-6783

Mailing address

PO Box 2876
Moultrie, GA 31776-2876
Phone (229) 891-9581

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240108000230 GA Practitioner - Physician Assistant 7911358627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sterling Orthopedics LLCGroup PAC ID 6507130598, 4 clinicians

Practice addresses (Care Compare)

16 Live Oak CT
Moultrie, GA 31768-6783
Phone (229) 785-2400

3131 S Main St
Moultrie, GA 31768-6925
Phone (229) 785-2400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
12001GAMDPsychologist

Organizations & group practices 1

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 2

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": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1104699628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-9581",
            "fax_number": "229-502-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 LIVE OAK CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686783",
            "telephone_number": "229-785-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLAR",
        "first_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-06",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "12001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.