NPIMap

Individual provider Active NPI

Benjamin Tackett, FNP

  • Family Nurse Practitioner
  • Logan, WV
National Provider Identifier
1265959704
Registry record updated Aug 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
66717 Issued in WV
Practice address
140 Stollings Ave Ste 1
Logan, WV 25601-4035
Phone
(304) 752-2555
NPI assigned
Aug 25, 2017
Last updated
Aug 25, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 66717 WV Primary

Addresses

Primary practice location

140 Stollings Ave Ste 1
Logan, WV 25601-4035

Mailing address

140 Stollings Ave Ste 1
Logan, WV 25601-4035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20171211000471 WV Practitioner - Nurse Practitioner 5991063406 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1220 Lee St E
Suite 100
Charleston, WV 25301-1864
Phone (304) 388-1965

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
66717WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Jun 29, 2024 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jun 29, 2024 Accepting new patients
Logan General Hospital LLC CurrentSince Oct 10, 2017 Accepting new patients
Appalachia Pathology Consultants LLC Current Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

1220 Lee St E
Ste 100
Charleston, WV 25301
Phone (304) 388-1965

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

258 Hanging Rock Hwy
Ste 1
Logan, WV 25601
Phone (304) 752-2555

20 Hospital Dr
Logan, WV 25601
Phone (304) 792-1101

Organizations & group practices 5

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503619200000",
    "number": "1265959704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE STE 1",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 STOLLINGS AVE STE 1",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014035",
            "telephone_number": "304-752-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "BENJAMIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "66717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.