Individual provider Active NPI

Benjamin Lee Wightman, AUD

  • Audiologist
  • Ann Arbor, MI
National Provider Identifier
1316248883
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1601000569 Issued in MI
Practice address
1500 East Medical Center Drive
1St Floor Taubman Center Recp a
Ann Arbor, MI 48109-5312
Phone
(734) 936-8051
Fax
(734) 936-8052
NPI assigned
Nov 15, 2010
Last updated
Dec 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1601000569 MI Primary

Addresses

Primary practice location

1500 East Medical Center Drive
1St Floor Taubman Center Recp a
Ann Arbor, MI 48109-5312

Mailing address

3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other names 1

  • Benjamin Lee Wightman Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1601000569MIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
J & a Lypka Corporation Audiologist PastSince Nov 15, 2012 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1316248883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE STREET",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DRIVE",
            "address_2": "1ST FLOOR TAUBMAN CENTER RECP A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095312",
            "telephone_number": "734-936-8051",
            "fax_number": "734-936-8052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGHTMAN",
        "first_name": "BENJAMIN",
        "middle_name": "LEE",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-15",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601000569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BENJAMIN",
            "last_name": "WIGHTMAN",
            "middle_name": "LEE",
            "credential": "AUD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.