NPIMap

Individual provider Active NPI

Benjamin James Missick, M.D.

  • Family Medicine Physician
  • Charlotte, NC
National Provider Identifier
1457557548
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
201001144 Issued in NC
Practice address
5815 Blakeney Park Dr
Suite 200B
Charlotte, NC 28277-5731
Phone
(704) 316-5080
Fax
(704) 316-5085
NPI assigned
Jun 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 201001144 NC Primary

Addresses

Primary practice location

5815 Blakeney Park Dr
Suite 200B
Charlotte, NC 28277-5731

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other identifiers 2

IdentifierTypeStateIssuer
NC1683MedicaidSC
5915631MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bmissick15415@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100911000101 NC Practitioner - Family Practice 0547385767 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLC 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

1450 Matthews Township Pkwy
Suite 400
Matthews, NC 28105-5336
Phone (704) 316-5410

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Charlotte, NC, CCN 347091
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Huntersville Medical Center Hospital, Huntersville, NC, CCN 340183

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201001144NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Feb 1, 2023 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Feb 1, 2023 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

200 Greenwich Rd
Charlotte, NC 28211
Phone (704) 384-8680

7903 Providence Rd
Ste 100
Charlotte, NC 28277
Phone (704) 316-4460

5815 Blakeney Park Dr
Ste 200B
Charlotte, NC 28277
Phone (704) 316-5080

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

1450 Matthews Township Pkwy
Ste 400
Matthews, NC 28105
Phone (704) 316-5140

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: bmissick15415@direct.novanthealth.org

Organizations & group practices 17

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 17

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": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1457557548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 BLAKENEY PARK DR",
            "address_2": "SUITE 200B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775731",
            "telephone_number": "704-316-5080",
            "fax_number": "704-316-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISSICK",
        "first_name": "BENJAMIN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-25",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "201001144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC1683",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5915631",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bmissick15415@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "5815 Blakeney Park Dr",
            "address_2": "Suite 200B",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282775731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.