NPIMap

Individual provider Active NPI

Benjamin Materi Jackson, MD

  • Vascular Surgery Physician
  • Allentown, PA
National Provider Identifier
1164588448
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD420325 Issued in PA
Practice address
1259 S Cedar Crest Blvd Ste 301
Allentown, PA 18103-6206
Phone
(610) 402-9400
Fax
(610) 437-8807
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD420325 PA
Vascular Surgery Physician 2086S0129X MT047810T PA
Vascular Surgery Physician 2086S0129X MD420325 PA Primary

Addresses

Primary practice location

1259 S Cedar Crest Blvd Ste 301
Allentown, PA 18103-6206

Mailing address

3400 Spruce Street
4 Silverstein Building
Philadelphia, PA 19104-4206
Phone (215) 615-4949

Other practice location 1

3400 Spruce Street
4 Silverstein Building
Philadelphia, PA 19104-4206
Phone (215) 615-4949

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
I20080529000531 PA Practitioner - Vascular Surgery 5597835827 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Perelman School of Med at the University of Pennsylvania, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1259 S Cedar Crest Blvd
301 LVPG Vascular Surgery
Allentown, PA 18103-6260
Phone (610) 439-0372

Hospital & facility affiliations

  • Lehigh Valley Home Care Home health agency, Allentown, PA, CCN 397023
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133
  • Schuylkill Medical Center - South Jackson Street Hospital, Pottsville, PA, CCN 390030
  • Lehigh Valley Hospital - Hazleton Hospital, Hazleton, PA, CCN 390185
  • Lehigh Valley Hospital - Macungie Hospital, Macungie, PA, CCN 390430
  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)19
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD420325PAMDVascular Surgery Physician
MT047810TPAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group Surgery CurrentSince Jul 11, 2022 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jul 11, 2022 Accepting new patients
University of Penn - Medical Group CurrentSince May 1, 2015 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince May 1, 2015 Accepting new patients
Lehigh Valley Hospital Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

1259 S Cedar Crest Blvd
Ste 301
Allentown, PA 18103
Phone (610) 402-9400

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

3400 Spruce St
Fl 4
Philadelphia, PA 19104
Phone (215) 662-2050

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

Interoperability endpoints

  • Direct secure messaging: bjackson103155@direct2.lvhn.org

Organizations & group practices 7

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 12

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1164588448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "4 SILVERSTEIN BUILDING",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044206",
            "telephone_number": "215-615-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 S CEDAR CREST BLVD STE 301",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036206",
            "telephone_number": "610-402-9400",
            "fax_number": "610-437-8807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 Spruce Street",
            "address_2": "4 Silverstein Building",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044206",
            "country_code": "US",
            "telephone_number": "215-615-4949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BENJAMIN",
        "middle_name": "MATERI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD420325",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MT047810T",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD420325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.