Individual provider Active NPI

Benjamin C Gillen, MD

  • Diagnostic Radiology Physician
  • Waukesha, WI
National Provider Identifier
1316108343
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
63398 Issued in WI
Practice address
W231N1440 Corporate CT
Waukesha, WI 53186-1303
Phone
(262) 896-6000
Fax
(920) 288-4956
NPI assigned
Jun 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 51114 MN
Vascular & Interventional Radiology Physician 2085R0204X 01072278A IN
Vascular & Interventional Radiology Physician 2085R0204X 63398 WI
Diagnostic Radiology Physician 2085R0202X 63398 WI Primary

Addresses

Primary practice location

W231N1440 Corporate CT
Waukesha, WI 53186-1303

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 3

IdentifierTypeStateIssuer
ENROLLEDMedicaidIA
100002569MedicaidWI
ENROLLEDMedicaidMN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bgillen145388@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150508001768 WI Practitioner - Diagnostic Radiology 7911073739 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York at Buffalo School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

2845 Greenbrier Rd
Green Bay, WI 54311-6519
Phone (920) 288-8100

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

Hospital & facility affiliations

  • Aurora Medical Center Bay Area Hospital, Marinette, WI, CCN 520113
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207
  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51114MNMDDiagnostic Radiology Physician
63398WIMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baycare Clinic LLP CurrentSince Apr 1, 2015 Accepting new patients
Aurora Medical Group, Inc. Diagnostic Radiology Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2015 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Jan 1, 2023 Accepting new patients
Aurora Advanced Healthcare, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Apr 1, 2015 Accepting new patients
Aurora Health Care Metro, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Baycare Clinic LLP CurrentSince Apr 1, 2015 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Jan 1, 2023 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

1035 Kepler Dr
Green Bay, WI 54311

2581 Development Dr
Green Bay, WI 54311
Phone (920) 347-0400

164 N Broadway
Green Bay, WI 54303
Phone (920) 965-4055

1160 Kepler Dr
Green Bay, WI 54311
Phone (920) 288-5400

2845 Greenbrier Rd
Green Bay, WI 54311
Phone (920) 288-3388

3003 University Dr
Marinette, WI 54143
Phone (715) 735-4200

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

2900 W Oklahoma Ave
Milwaukee, WI 53215
Phone (414) 385-2590

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

719 Doctors Ct
Oshkosh, WI 54901
Phone (920) 235-0066

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

Interoperability endpoints

  • Direct secure messaging: bgillen145388@direct.myadvocateaurora.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 8

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": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1316108343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W231N1440 CORPORATE CT",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531861303",
            "telephone_number": "262-896-6000",
            "fax_number": "920-288-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLEN",
        "first_name": "BENJAMIN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-23",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "51114",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IN",
            "license": "01072278A",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "WI",
            "license": "63398",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "63398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002569",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bgillen145388@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2845 Greenbrier Rd",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543116519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.