NPIMap

Individual provider Active NPI

Benjamin Mullenbach, MD

  • Diagnostic Radiology Physician
  • Mount Pleasant, SC
National Provider Identifier
1194135442
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD83497 Issued in SC
Practice address
1241 Woodland Ave
Mt Pleasant, SC 29464-3288
Phone
(843) 824-0606
Fax
(843) 824-0909
NPI assigned
May 7, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 201220 NC
Diagnostic Radiology Physician 2085R0202X MD83497 SC Primary

Addresses

Primary practice location

1241 Woodland Ave
Mt Pleasant, SC 29464-3288

Mailing address

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 446-1242

Other practice location 1

1350 S Kings Dr
Charlotte, NC 28207-2134
Phone (704) 446-1242

Other identifiers 1

IdentifierTypeStateIssuer
12501QMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20200511000202 SC Practitioner - Diagnostic Radiology 6406168772 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Georgia School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pelican II LLCGroup PAC ID 1759484082, 18 clinicians
Charleston Radiologists PAGroup PAC ID 9436054715, 35 clinicians

Practice addresses (Care Compare)

1241 Woodland Ave
Mt Pleasant, SC 29464-3288
Phone (843) 881-4020

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.62 of 100Reported as group
Quality
79.55
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD83497SCMDDiagnostic Radiology Physician
201220NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Radiologists PA Diagnostic Radiology CurrentSince Jun 1, 2020 Accepting new patients
Pelican II, LLC Diagnostic Radiology CurrentSince Jun 1, 2020 Accepting new patients

Locations

1241 Woodland Ave
Mt Pleasant, SC 29464
Phone (843) 881-4020

Organizations & group practices 2

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 10

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": "1399420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1194135442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072134",
            "telephone_number": "704-446-1242",
            "fax_number": "704-446-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 WOODLAND AVE",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643288",
            "telephone_number": "843-824-0606",
            "fax_number": "843-824-0909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 S Kings Dr",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072134",
            "country_code": "US",
            "telephone_number": "704-446-1242",
            "fax_number": "704-446-1241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLENBACH",
        "first_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-07",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "201220",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "MD83497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12501Q",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.