Individual provider Active NPI

Benjamin George Banapoor, MD

  • Emergency Medicine Physician
  • Atlanta, GA
National Provider Identifier
1538656608
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
84027 Issued in GA
Practice address
1364 Clifton Rd NE
Atlanta, GA 30322-1059
Phone
(404) 251-8865
NPI assigned
Apr 15, 2018
Last updated
May 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X 84027 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Atlanta, GA 30322-1059

Mailing address

44 Krog St NE Unit 202
Atlanta, GA 30307-2643
Phone (321) 591-3650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210511002140 GA Practitioner - Emergency Medicine 7012266075 Reassigns benefits to 2 organizations
I20220808002580 FL Practitioner - Emergency Medicine 7012266075 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Florida College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Physician Associates PLLCGroup PAC ID 1850535048, 221 clinicians

Practice addresses (Care Compare)

1350 Hickory St
Melbourne, FL 32901-3224
Phone (321) 434-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
84027GAMDEmergency Medicine Physician
010232GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Apr 15, 2022 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Brevard Physician Associates, PLLC Emergency Medicine CurrentSince Aug 15, 2022 Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine CurrentSince May 1, 2021 Accepting new patients

Locations

1350 Hickory St
Melbourne, FL 32901
Phone (321) 434-1771

1364 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 712-7100

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Interoperability endpoints

  • Direct secure messaging: bbanapoor71612@epicdirect.hf.org
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 4

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 3

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": "1523750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1538656608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 KROG ST NE UNIT 202",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303072643",
            "telephone_number": "321-591-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221059",
            "telephone_number": "404-251-8865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANAPOOR",
        "first_name": "BENJAMIN",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-15",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "84027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.