Individual provider Active NPI

Benjamin H Taylor Jr., PA

  • Physician Assistant
  • Augusta, GA
National Provider Identifier
1104911049
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003109 Issued in GA
Practice address
1120 15TH Street
Augusta, GA 30912
Phone
(706) 721-4951
Fax
(706) 721-7941
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003109 GA Primary

Addresses

Primary practice location

1120 15TH Street
Augusta, GA 30912

Mailing address

1499 Walton Way
Ste 1400
Augusta, GA 30901-2650
Phone (706) 724-6100

Other identifiers 2

IdentifierTypeStateIssuer
0056PAMedicaidSC
1000002361AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070103000099 SC Practitioner - Physician Assistant 5395745095 Reassigns benefits to 1 organization
I20090216000101 GA Practitioner - Physician Assistant 5395745095 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
505SCMDPediatric Physical Therapist
003109GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sterling Emergency Services of the Southeast Inc Past Accepting new patients
Inphynet Primary Care Physicians Southeast PC Physician Assistant Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104911049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 WALTON WAY",
            "address_2": "STE 1400",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012650",
            "telephone_number": "706-724-6100",
            "fax_number": "706-722-5187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH STREET",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "30912",
            "telephone_number": "706-721-4951",
            "fax_number": "706-721-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "BENJAMIN",
        "middle_name": "H",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056PA",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000002361A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.