Ben Prom

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

8505 Old Dairy Rd
Juneau, AK 99801-6921

Phone

(907) 790-4111

NPI assigned

Nov 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Divine Savior Healthcare IncGroup PAC ID 5799684007, 135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aspirus Divine Savior Hospital Hospital, Portage, WI, CCN 520041

Merit-based Incentive Payment System (MIPS)

Final score

91.7 of 100Reported as group

Quality

91.14

Promoting interoperability

100

Improvement activities

40

Cost

77.5

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Divine Savior Healthcare, Inc.

  dba Aspirus Divine Savior Hospital

  • General Acute Care Hospital
  • Portage, WI
  • NPI 1124083894
  Medicare reassignment Care Compare group
• Juneau Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • Juneau, AK
  • NPI 1912393356
  Medicare reassignment
• Divine Savior Healthcare, Inc.

  dba Aspirus Portage Clinic

  • Rural Health Clinic/Center
  • Portage, WI
  • NPI 1386154417
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Divine Savior Healthcare, Inc.

  dba Aspirus Divine Savior Hospital

  • General Acute Care Hospital
  • Portage, WI
  • NPI 1124083894
  Care Compare affiliation

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

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1629733415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8505 OLD DAIRY RD",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998016921",
            "telephone_number": "907-790-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8505 OLD DAIRY RD",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998016921",
            "telephone_number": "907-790-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROM",
        "first_name": "BEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-05",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Priority Home Healthcare
• Prism Eye Associates LLC (Juneau Eye Care)
• Prism Midwifery LLC
• Mitzi Larae Privett, MSW
• Progressions Alaska LLC (Progressions Physical Therapy)
• Kellee Purdy, LCSW
• Mei Qiu, LMSW
• Nicole Quinto
• Niima Radford
• Richard Radford

• Physician Assistant in Juneau, AK
• Providers in Juneau, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.