NPIMap

Individual provider Active NPI

Edward J Benak, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Montgomery, AL
National Provider Identifier
1376612457
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
10291 Issued in AL
Practice address
225B Winton M Blount Loop
Montgomery, AL 36117-3507
Phone
(334) 263-6228
Fax
(334) 265-9136
NPI assigned
Nov 6, 2006
Last updated
Sep 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 10291 AL Primary

Addresses

Primary practice location

225B Winton M Blount Loop
Montgomery, AL 36117-3507

Mailing address

225B Winton M Blount Loop
Montgomery, AL 36117-3507
Phone (334) 263-6228

Other identifiers 1

IdentifierTypeStateIssuer
000086420MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20101123001069 AL Practitioner - Pathology 8820284359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Alabama School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alabama Pathology AssociatesGroup PAC ID 8325026990, 3 clinicians

Practice addresses (Care Compare)

225 B Winton Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

225 B Winton M Blount Loop
Montgomery, AL 36117-3507

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alabama Pathology Associates CurrentSince Mar 1, 2012 Accepting new patients
Alabama Pathology Associates CurrentSince Mar 1, 2012 Accepting new patients
Laboratory Corporation of America Holdings Past Accepting new patients

Locations

2019 Clubview St
Montgomery, AL 36106
Phone (334) 263-6228

225B Winton Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

225B Winton M Blount Loop
Montgomery, AL 36117
Phone (334) 263-6228

Organizations & group practices 3

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 5

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1376612457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225B WINTON M BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-263-6228",
            "fax_number": "334-265-9136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225B WINTON M BLOUNT LOOP",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173507",
            "telephone_number": "334-263-6228",
            "fax_number": "334-265-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENAK",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AL",
            "license": "10291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000086420",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.