NPIMap

Individual provider Active NPI

Kenneth James Benjamin, MD

  • Internal Medicine Physician
  • Cordele, GA
National Provider Identifier
1245344928
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
42527 Issued in GA
Practice address
902 N 7TH St
Cordele, GA 31015-3234
Phone
(229) 276-3325
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 042527 GA
Internal Medicine Physician 207R00000X 42527 GA Primary

Addresses

Primary practice location

902 N 7TH St
Cordele, GA 31015-3234

Mailing address

902 N 7TH St
Cordele, GA 31015-3234
Phone (229) 276-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20031121000774 GA Practitioner - Emergency MedicinePractitioner - Internal Medicine 7315841210 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
University of Texas Medical Branch at Galveston, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southland Bainbridge Hospitalist Group, LLCGroup PAC ID 7214248335, 54 clinicians
Crisp Regional Hospital IncGroup PAC ID 5991616336, 65 clinicians

Practice addresses (Care Compare)

90 E Stephens St
Camilla, GA 31730-1836
Phone (229) 336-5284

902 N 7TH St
Cordele, GA 31015-3234
Phone (229) 276-3100

Hospital & facility affiliations

  • Pruitthealth Hospice-Cordele Hospice, Cordele, GA, CCN 111578
  • Crisp Regional Hospital Hospital, Cordele, GA, CCN 110104
  • Archbold Mitchell Hospital, Camilla, GA, CCN 111331
  • Archbold Mitchell Nursing home, CCN 11Z331

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42527GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southland Emergency Medical Services, L.L.C Emergency Medicine CurrentSince Aug 17, 2014 Accepting new patients
Crisp Regional Hospital, Inc CurrentSince Jul 1, 2005 Accepting new patients
Crisp Regional Hospital Inc Internal Medicine CurrentSince Jul 1, 2005 Accepting new patients
Southland Bainbridge Hospitalist Group, LLC CurrentSince Jun 1, 2016 Accepting new patients
Southland Consolidated Emergency Services, LLC Emergency Medicine CurrentSince Oct 1, 2019 Accepting new patients
Hospital Authority of Mitchell County Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
Hospital Authority of Calhoun County Past Accepting new patients
Calhoun Memorial Hospital Past Accepting new patients

Locations

1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100

1155 5th St SE
Cairo, GA 39828
Phone (229) 226-3060

90 E Stephens St
Camilla, GA 31730
Phone (229) 200-4950

307 E 3rd Ave
Cordele, GA 31015
Phone (229) 271-4612

902 N 7th St
Cordele, GA 31015
Phone (229) 276-3100

4 Medical Dr
Elberton, GA 30635
Phone (706) 213-2527

903 N Court St
Quitman, GA 31643
Phone (229) 263-4531

Interoperability endpoints

  • Direct secure messaging: kenneth.benjamin@crispregional.gadirect.net

Organizations & group practices 9

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 4

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1245344928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 N 7TH ST",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153234",
            "telephone_number": "229-276-3100",
            "fax_number": "229-271-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N 7TH ST",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153234",
            "telephone_number": "229-276-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENJAMIN",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "042527",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "42527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordele, GA

Sources for this page

Verify at the official NPI Registry.