Benjamin Ray Eliason, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

10366261-1205 Issued in UT

Practice address

1654 W Reunion Ave Ste 10B
South Jordan, UT 84095-4676

Phone

(801) 349-2480

Fax

(801) 363-4885

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Psychiatry

Education

Medical College of Wisconsin, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dynamic Psychiatry PLLCGroup PAC ID 0840667614, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Dynamic Psychiatry PLLC

  • Psychiatry Physician
  • South Jordan, UT
  • NPI 1679225536
  Medicare reassignment Care Compare group NPD
• Physician Group of Utah Inc

  • Specialist
  • South Jordan, UT
  • NPI 1477676930

  Clinic/Center

  Medicare reassignment NPD
• ZHC Utah LLC

  • Adult Mental Health Clinic/Center
  • Murray, UT
  • NPI 1356073878
  Medicare reassignment NPD
• Canvas Health, Inc.

  • Mental Health Counselor
  • Oakdale, MN
  • NPI 1922051325

  Clinic/Center

  NPD
• Dynamic Psychiatry & Wellness

  • Multi-Specialty Clinic/Center
  • Lehi, UT
  • NPI 1265324628
  NPD (past)
• County of Milwaukee

  • Psychiatry Physician
  • Milwaukee, WI
  • NPI 1831256353
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1659418267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10471 S ALEXANDER PARK LN",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953121",
            "telephone_number": "541-678-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1654 W REUNION AVE STE 10B",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954676",
            "telephone_number": "801-349-2480",
            "fax_number": "801-363-4885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7066 Stillwater Blvd N",
            "address_purpose": "LOCATION",
            "city": "Oakdale",
            "state": "MN",
            "postal_code": "551283937",
            "country_code": "US",
            "telephone_number": "651-777-5222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELIASON",
        "first_name": "BENJAMIN",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "10366261-8905",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "75589",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "MD125756",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD125756",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "10366261-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lars M Eggertsen, MSW, CSW
• David Lambert Egli, M.D.
• Tarhonda Eiland
• Kailee Ekenstam
• Elevated Youth Services (Elevated)
• Sanni Elison
• Timothy B. Elison, D.M.D.
• Elite Performance Health Center, PC
• Ciera Nicole Elliott
• Melissa Ellsworth, PHD

• Psychiatry Physician in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.