Active NPI
Benjamin Leon Clyde, DC
- Chiropractor
- Morgantown, PA
National Provider Identifier
1376773762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC010140
- Practice address
- 3025 Main Street
Suite 1
Morgantown, PA 19543-7754 - Phone
- (610) 901-3380
- Fax
- (610) 901-3380
- NPI assigned
- Jul 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC010140 | PA | Primary |
Addresses
Primary practice location
3025 Main Street
Suite 1
Morgantown, PA 19543-7754
Mailing address
PO Box 385
Morgantown, PA 19543-0385
Phone (610) 901-3380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090825000343 | PA | Practitioner - Chiropractic | 5597819680 | Practice locations: Morgantown, PA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3025 Main St
Morgantown, PA 19543-7744
Phone (610) 901-3380
PO Box
Suite 385
Morgantown, PA 19543
PO Box
Suite 385
Morgantown, PA 19543-0385
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC010140 | PA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509494400000",
"number": "1376773762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 385",
"city": "MORGANTOWN",
"state": "PA",
"postal_code": "195430385",
"telephone_number": "610-901-3380",
"fax_number": "610-901-3380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3025 MAIN STREET",
"address_2": "SUITE 1",
"city": "MORGANTOWN",
"state": "PA",
"postal_code": "195437754",
"telephone_number": "610-901-3380",
"fax_number": "610-901-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYDE",
"first_name": "BENJAMIN",
"middle_name": "LEON",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-20",
"last_updated": "2017-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "PA",
"license": "DC010140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.