Individual provider Active NPI

Austin Charles Benner, PA-C

  • Physician Assistant
  • Middleburg, PA
National Provider Identifier
1124614953
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
OA005540 Issued in PA
Practice address
1 Dock Hill Rd
Middleburg, PA 17842-8910
Phone
(570) 837-5889
Fax
(570) 837-6600
NPI assigned
Dec 16, 2020
Last updated
Apr 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA062295 PA
Physician Assistant 363A00000X OA005540 PA Primary

Addresses

Primary practice location

1 Dock Hill Rd
Middleburg, PA 17842-8910

Mailing address

7 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-2123

Other identifiers 2

IdentifierTypeStateIssuer
1038793050001MedicaidPA
1N4857OtherPAMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address austinbennerpac@fpc.medentdirect.com Health Information Exchange (HIE) FAMILY PRACTICE CENTER, PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20210323002453 PA Practitioner - Physician Assistant 0749697571 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Center PCGroup PAC ID 0244124212, 351 clinicians

Practice addresses (Care Compare)

1 Dock Hill Rd
Middleburg, PA 17842-8910
Phone (570) 837-5889

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA062295PAMDPhysician Assistant
OA005540PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center, PC Multi-Specialty CurrentSince Mar 8, 2021 Accepting new patients

Locations

7 Dock Hill Rd
Middleburg, PA 17842
Phone (570) 837-2123

Interoperability endpoints

  • Direct secure messaging: austinbennerpac@fpc.medentdirect.com

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 1

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": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1124614953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-2123",
            "fax_number": "570-837-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DOCK HILL RD",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178428910",
            "telephone_number": "570-837-5889",
            "fax_number": "570-837-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNER",
        "first_name": "AUSTIN",
        "middle_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-16",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA062295",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA005540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1038793050001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1N4857",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "austinbennerpac@fpc.medentdirect.com",
            "affiliation": "Y",
            "affiliationName": "FAMILY PRACTICE CENTER, PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1 Dock Hill Rd",
            "city": "Middleburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "178428910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middleburg, PA

Sources for this page

Verify at the official NPI Registry.