NPIMap

Individual provider Active NPI

Benjamin Mark Watson, MD

  • Colon & Rectal Surgery Physician
  • Keesler AFB, MS
National Provider Identifier
1679078356
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
33762 Issued in MS
Practice address
301 Fisher St
Keesler AFB, MS 39534-2508
Phone
(228) 376-0425
NPI assigned
Mar 26, 2018
Last updated
Aug 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 161077 FL
Colon & Rectal Surgery Physician 208C00000X 33762 MS Primary

Addresses

Primary practice location

301 Fisher St
Keesler AFB, MS 39534-2508

Mailing address

301 Fisher St
Keesler AFB, MS 39534-2508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20250110000670 MS Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 6103176698 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Colorectal Surgery (Proctology)
Education
University of Alabama School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
Kings Daughters Medical CenterGroup PAC ID 3072575539, 75 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Suite 240
Gulfport, MS 39501-2465
Phone (228) 515-1200

427 Hwy 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
161077FLMDSurgery Physician
33762MSMDColon & Rectal Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kings Daughters Medical Center Single Specialty Current Accepting new patients
Memorial Hospital at Gulfport Single Specialty Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Dec 16, 2024 Accepting new patients
Biloxi Hma Physician Management LLC CurrentSince Jan 2, 2025 Accepting new patients
Biloxi Hma Physician Management LLC Single Specialty CurrentSince Jan 2, 2025 Accepting new patients
King's Daughters Medical Center CurrentSince Oct 1, 2025 Accepting new patients
Memorial Hospital at Gulfport Single Specialty CurrentSince Dec 16, 2024 Accepting new patients
King's Daughters Medical Center Single Specialty CurrentSince Oct 1, 2025 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

150 Reynoir St
Biloxi, MS 39530
Phone (228) 284-2389

427 Highway 51 N
Brookhaven, MS 39601
Phone (601) 833-6011

1340 Broad Ave
Ste 240
Gulfport, MS 39501
Phone (228) 515-1200

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

Organizations & group practices 10

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 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1679078356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342508",
            "telephone_number": "228-376-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "BENJAMIN",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "161077",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MS",
            "license": "33762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keesler AFB, MS

Sources for this page

Verify at the official NPI Registry.